ONE-SIZE-FITS-ALL APPROACH WON'T STOP HEROIN PLAGUE

Local Heroin Task Force Must Offer More Treatment Options.

They are 34-year-old tax consultants, 18-year-old high school students,
39-year-old housewives, 25-year-old warehouse workers.

The list of 48 heroin-related deaths in Luzerne County since 1997 presents a
cross-section of our adult population. Some might have tried heroin only a
few times before succumbing to an overdose. Some might have had drug habits
that lasted for years.

Still, as revealed in a three-part Times Leader series, "Valley with a
Habit,'' the Luzerne County Heroin Task Force insists that its single-minded
approach - heavy on education and enforcement but vehemently opposed to a
methadone-maintenance program - is the only approach.

We believe the members of the task force - a group consisting mostly of
local medical, law enforcement and treatment professionals - are sincere and
dedicated to the goal of saving lives.

But we also believe their insistence on opposing any local methadone clinic
that offers anything other than short-term, methadone-to-abstinence
treatment is ill-advised, counter to the opinions of most experts in the
field and bound to fail.

Even in pursuing that flawed treatment policy, the task force has exhibited
a stunning lack of urgency. After leading the charge against a proposed
methadone-maintenance clinic in 1998, the task force announced in November
1999 it would favor a methadone-to-abstinence clinic. But it has made little
discernible progress toward that goal.

After three years on the job, the task force can't even give the public a
definitive number of heroin-related deaths in the county since 1997.

"Your guess is as good as ours,'' task force co-chair Michael Donahue told
us. Yet our reporters were able to count 48 such deaths merely by studying
government documents already in the possession of county Coroner Dr. George
E. Hudock Jr., a founding member of the task force.

After three years on the job, can't co-chair Tom Cesarini come up with
anything better than: "We have enough information out there to show us what
we're dealing with. We have a problem. We have a serious problem.''?

For all its hand-wringing over that problem, the task force seems blissfully
uninterested in studying the approaches taken in other cities. No member
attended a national conference on preventing heroin deaths in Seattle.

And task force co-chair Donahue went so far as to say: "I don't really care
about ... I shouldn't say it that way ... I'm not concerned about'' programs
in Philadelphia and Allentown.

"Our problem is our problem. And my concern is our kids.''

Donahue, who directs a local treatment center, said long-term methadone
maintenance, in which daily doses might be administered for years, would
condemn young users to a life of dependency.

But he ignores the fact, illustrated by our survey of local heroin deaths,
that many local addicts are in their 30s and 40s and have presumably spent
years on heroin.

Those older addicts constitute a network that eases the entry of younger
people into heroin addiction, either through drug sales or just by bad
example. Their role in perpetuating the cycle of drug addiction among the
young should not be ignored.

Long-term methadone maintenance should be available locally for those older
addicts. Such treatment would allow them to live stable, productive lives
without the requirement of traveling to the nearest methadone clinic in
Allentown, something about two dozen local residents do daily.

But local methadone maintenance should be available for younger addicts too.
There is little evidence that methadone-to-abstinence, while it is certainly
an approach worth trying in many cases, will be effective in treating even
the youngest drug users with short-term addictions.

A 1994 study by the New York State Office of Alcoholism and Substance Abuse
concluded that 80 percent of patients in programs that demand abstinence
after a limited period of ever-decreasing dosages of methadone return to
heroin use within two years.

"Stubbornly clinging to the paradigm of abstinence as the only acceptable
therapeutic orientation ... condemns the vast majority of heroin addicts to
continued suffering and, all too often, to death,'' writes Dr. Robert
Newman, president of Beth Israel Medical Center in New York City, a pioneer
in methadone treatment.

Thankfully, the heroin task force has given itself some room to maneuver on
the abstinence issue - last year the task force was talking about a program
that would wean addicts from methadone after four to six months. Donahue is
now talking about a three-year program.

We hope the task force shows even more flexibility on this issue and comes
to realize that any local methadone clinic must offer a range of treatment
options tailored to suit each patient. While methadone-to-abstinence is
certainly a preferred approach, it won't work for all, or most, addicts.

It would be better to give those addicts a chance at a stable life through
methadone maintenance than to condemn them to a life on heroin and condemn
society to the attendant increases in crime, family dysfunction and
health-care expense.

But if the task force continues its current approach, our local anti-heroin
campaign will continue to resemble an out-of-kilter three-legged stool, with
the legs of education and enforcement dwarfing the stunted leg of available
treatment.

And more people will probably die.