TIME TO FIGHT HEROIN AND OPIATE PROBLEM IN MAINE

Dr. Erik Steele recently challenged all sides in the methadone debate
to set forth their positions "backed up by references to studies and
research" (BDN, July 11). In response, I offer the following excerpts
from a position paper, the full version of which contains complete
citation to supporting data. We have also submitted the supporting
data (roughly 1,300 pages) in the form of research notebooks.

Parties interested in receiving a copy of our annotated report may
contact my office at 945-0373.

As U.S. attorney for the district of Maine, I believe that a long-term
methadone maintenance clinic is not in the best interest of the
Greater Bangor community at this time. It is essential to understand
that we are at the very early stages of a heroin problem in the Bangor
area. It has been only within the last 12 to 18 months that heroin --
in any significant amount -- has been in Bangor. It is also essential
to understand that the earlier heroin users begin treatment, the
easier heroin is to beat and the greater the chances are of success.

Methadone maintenance, however, is not an appropriate treatment for
new users.

In fact, under FDA regulations, long-term methadone maintenance can
only be initiated if an addict has been addicted for at least one
year. This is so because methadone is itself a highly addictive
narcotic -- some say methadone is more addictive than heroin.

Joanne Augden of the Office of Substance Abuse told the Bangor City
Council that people on methadone maintenance will need to continue
treatment into the nursing home. John Destefano, the regional director
of the Discovery House (a methadone maintenance provider in Portland)
has indicated that "less than 10 percent" of those on methadone
maintenance "taper off the drug. For most, the dosage increases along
with tolerance." The reality is that most addicts do not stay on
methadone.

Bangor presently has a small number of addicts -- between 29 and 40 --
who receive methadone maintenance treatment at the methadone clinic in
Winslow. Acadia estimates, however, that it will serve 150 addicts at
its Bangor methadone clinic.

It is clear that a methadone maintenance clinic will attract hard-core
addicts (addicts who have been addicted for at least a year) to Bangor.

In order to define methadone maintenance as an "effective" treatment,
proponents have set the bar for success very low. Most methadone
studies consider methadone a "successful" or "effective treatment as
long as the overall use of heroin for the methadone-maintained patient
is less than it was before treatment began.

In other words, if a heroin addict with a daily habit enters methadone
treatment and manages to cut his requirement for heroin by any amount,
his methadone maintenance is considered effective or successful. This
is called "harm reduction" theory.

Heroin dealers are known for targeting methadone clinics where they
can be assured of a market.

David Smith, a recovering heroin addict who testified to the Bangor
City Council, said: "If this methadone clinic was up here when I come
up here two years ago, and I knew it was up here, I'd probably set up
shop right outside the door [be]cause that would be the best place to
sell ... because it happens down in Portland at the methadone clinic
down there without a doubt."

Here is where the "harm reduction" theory does not work. It may be
fair to say that overall use of heroin will decline with methadone
maintenance in New York City, which has residing in it more hard-core
heroin addicts than treatment slots available.

But in Bangor we will be importing addicts (who by regulation must
have already been addicted for at least one year) from around the state.

There is no doubt that those who fail on methadone maintenance, those
who never intended to use methadone maintenance to stop their illegal
drug use, and those who target methadone maintenance clinics to sell
heroin, will addict new people to heroin.

Once new users begin to use heroin they, in turn, will deal to support
their habits and will, in turn, addict new users.

Overall drug use in the Greater Bangor area will not decline.

It will increase. Rather than reduce harm, a methadone maintenance
clinic in Bangor will produce harm. This is why it is so imperative to
drive out heroin. The only truly effective way to stop heroin is not
to start heroin.

Several treatment options exits that are less addictive and less
controversial than methadone.

Clonidine may be used for symptom management during detoxification.
Anti-anxiety medicines, blood pressure medicines, nausea controllers
and sleep medications as well as other drugs may be prescribed for
symptom relief during detoxification. Buprenorphine (Buprenex),
currently used as a detoxification medicine, will soon be available
for maintenance and is a promising alternative to methadone.

Naltrexone treatment is another alternative drug which eliminates the
effect of opiate drugs and offers the user no drug effect if he or she
uses opiates while on Naltrexone therapy.

Several new drugs, such as Suboxone, which offer addicts less
addictive alternatives to treatment than methadone, are nearing FDA
approval.

USA Today reported that a "combination of two drugs, in a once-a-day
pill could be approved by the Food and Drug Administration as early as
September."

Contrary to what some believe, I have never believed that law
enforcement alone can handle this problem.

That is why, in February, my office formed the Communities Against
Heroin Committee made up of a broad-based group of area educators,
physicians, pharmacists, other health care providers, clergy, members
of the media and business people. We have been meeting extensively in
the intervening months to develop and implement strategies to drive
heroin out of this community. I have also begun efforts to set up
similar committees in Washington and Hancock counties.

We have held education programs in the Bangor and Mt. Desert high
schools. We have started a working group of medical people to devise a
system to curtail fraudulent prescriptions. The treatment committee
has established an alternative treatment program appropriate to the
heroin problem this community faces.

The media committee will have radio and television ads ready to go by
September. The clergy committee has begun to "spread the word." The
business group is working on heroin training for managers.

We have applied for additional federal and state grant money to help
with this enormous challenge.

We have received a gratifying response from many in the Bangor
community who want to help. And, whether we get a methadone clinic or
not, we will need all the help we can get to fight the heroin and
opiate problem.