METHADONE CLINIC MORATORIUM IN BANGOR

Barry McCaffrey, director of the Office of National Drug Control Policy,
misses the point of my opposition to a methadone clinic for Bangor. I am
not opposed to methadone maintenance in all circumstances, and I agree that
methadone has a place as a last resort treatment for hard-core heroin and
opiate addicts.

My concern is that in a city the size of Bangor, which has a relatively new
heroin problem (12 to 18 months), which has a relatively low number of
addicts for whom methadone maintenance is an appropriate treatment, and
which will be drawing hard-core addicts from outside the area, a methadone
clinic will have more negative than positive effects. My concern is that a
methadone clinic in Bangor (which is a regional service center for a large
geographic area) will attract hard-core addicts, many of whom will drop out
or fail. Once here, those addicts who are unsuccessful or who continue to
use illicit drugs during treatment will addict new users because they will
deal illegal drugs to support their drug habits.

It is to prevent the further growth of the heroin-opiate problem that I
have asked for a two-year moratorium on methadone clinics in Bangor. During
these two years, we hope to greatly reduce the supply of heroin through an
intensive law enforcement effort and also to greatly reduce the demand for
heroin and opiates through prevention and education. During these two
years, methadone maintenance will be available 45 miles away in Winslow for
those who really need it.

From a law enforcement perspective, we are fortunate to be at the end of
the drug distribution pipeline. The supply of drugs like heroin can be
significantly reduced with intensive law enforcement efforts. Since
January, we have arrested more than 50 individuals who have been dealing
heroin and other opiates, some of whom were major suppliers to the
Penobscot and Hancock County areas. We know we have already had a
substantial impact, because the price of heroin on the street is up 75
percent. Ironically, in 1999, ONDCP rejected the request of the New England
United States Attorneys to include Penobscot, Aroostook and Androscoggin
Counties in the New England High-Intensity-Drug-Trafficking Area (HIDTA)
funding. On the prevention side, communities against heroin have made
substantial progress. We have already had feedback from educators, doctors
and pharmacists that our prevention efforts are having an impact.

The newness of Bangor's heroin and opiate problem is evidenced both by law
enforcement intelligence and by the Office of Substance Abuse's own
statistics. While the Office of Substance Abuse keeps referring to the
four-fold increase in heroin and opiate addiction since 1995, a look at the
numbers reveals that the real jump in heroin and opiate use in Penobscot
County came in 1999. OSA reported the following as numbers of people from
Penobscot County who were admitted to drug treatment programs for heroin
and other opiates (primary, secondary, and tertiary substances)

37 48 54 61 146

1995 1996 1997 1998 1999

OSA also has reported that Penobscot County's heroin admissions (primary,
secondary and tertiary substances used/abused) actually dropped in 1998 to
a four-year low and were up dramatically in 1999

22 28 26 17 48

1995 1996 1997 1998 1999

Additionally, although you can generally conclude from this data that the
heroin and opiate problem has increased substantially in 1999, it is not
clear from these numbers how many people are actually addicted to heroin or
other opiates as opposed to simply having used or abused these drugs. For
instance, a person whose primary reason for seeking treatment is cocaine,
but who also has used heroin on occasion, would be included in the heroin
figures.

The high failure rates of methadone maintenance have not been seriously
disputed. What the studies show 97 and these are studies from the 1990s of
programs which implement the recent advances shown for higher doses and
adjunct counseling services 97 is that methadone maintenance addicts fail
in three ways. The DATOS study cited by ONDCP states that retention rates
for outpatient methadone treatment range from 15 percent to 76 percent.
That means at least 24 percent and as high as 85 percent of the people who
start methadone treatment will drop out.

Second, studies show that a high percentage of addicts on methadone
maintenance continue to use cocaine, heroin and other illegal drugs. The
Journal of the American Medical Association (March 8) reported that the
comorbid use of cocaine ranged from 50 percent to 70 percent and comorbid
use of heroin was over 50 percent in the methadone maintenance patients
studied. Finally, even the most pro-methadone articles admit"In most
studies about 80 percent of the former patients relapse to use of heroin
and-or other narcotics within approximately two years after leaving
treatment." ("Methadone Treatment WorksA Compendium for Methadone
Maintenance Treatment," New York State Office of Alcoholism and Substance
Abuse Services, December 1994.)

ONDCP points to the DATOS study for support of its claim that methadone
maintenance works. The study, available at www.datos.org/highlights
http//www.datos.org, is entirely based on self-reports by the methadone
maintenance addicts. There are numerous studies which establish that
self-reported data of addicts on methadone is not reliable. (National
Institute of Drug Abuse (NIDA) Research Monograph 167 at 204, citing
studies.) Furthermore, ONDCP's claim that methadone maintenance "helps keep
179,000 addicts off heroin, off welfare, and on the tax rolls as law
abiding citizens" is a total exaggeration. One only has to remember the
rates of comorbid heroin and cocaine use to know that many on methadone
maintenance are not law-abiding and are not off other illicit drugs. As for
welfare and tax rolls, approximately 80 percent of those presently
receiving meth-adone maintenance both in Maine and nationally have
treatment paid for by Medicaid and are unemployed.

A bill allowing doctors to dispense buprenorphine has already passed the
House and will likely be approved by the Senate this September. FDA
approvals are expected by year's end. Buprenorphine has been hailed by the
president of the American Academy of Addiction Psychiatry as superior to
methadone maintenance "on every outcome measure." According to the director
of NIDA, buprenorphine and buprenorphine-naloxone will expand "treatment to
populations who either do not have access to methadone programs or are
unsuited to them, such as adolescents ... and new heroin addicts."

Vermont has already passed legislation requiring that buprenorphine be the
"drug of first choice" rather than methadone. Because physicians will
dispense buprenorphine from their offices, large numbers of addicts won't
need to travel (or relocate) to Bangor to receive treatment. Doesn't it
make sense to postpone a methadone clinic for Bangor for a few months until
these new drugs are available, rather than bring in a methadone clinic
which will institutionalize and centralize the heroin and opiate problem in
Bangor?

Some contend that holding off on methadone to wait for buprenorphine is
like telling a cancer patient to wait for a new remedy. But unlike cancer
patients, heroin and opiate addicts deal to others, making their "illness"
particularly damaging to others in society. And in the interest of the
greater good of the community, asking an addict to drive to Winslow for
methadone maintenance for the next two years seems like a reasonable request.