HARBORVIEW FIRST HOSPITAL IN NATION TO OFFER METHADONE TREATMENT

Beginning today, selected heroin addicts can receive methadone treatment
through Harborview Medical Center's pharmacy. It is the first such
hospital-based clinic in the nation, officials said.

Health officials hope opening the new program will help ease the logjam of
addicts waiting for treatment in the Seattle area's three traditional
clinics. Drug-abuse experts say Seattle has one of the worst heroin problems
in the nation.

"This is for patients who have been in treatment for a long time and who
have been stable for a long time. There is no need for them to be in a
clinic every week with less stable patients," said Dr. Joseph Merrill, a
University of Washington researcher who directs the project.

The program is affiliated with Evergreen Treatment Services, a long-standing
methadone-treatment clinic in Seattle. It will serve as a model for studying
how to integrate stable patients into a traditional medical practice.

"These are basically recovered addicts who need medication and may have
other medical problems," said Ron Jackson, director of Evergreen. "It moves
them from the more specialized care to a regular medical provider."

Evaluation of the program, including its implications for other projects, is
being financed by a $350,000, three-year grant from the Robert Wood Johnson
Foundation, long involved in health-care research. Patients' treatment is
paid by their own insurance or Medicaid, or by themselves.

Health officials estimate there are 8,000 to 10,000 heroin users in King
County, with as many as 675 on treatment waiting lists. The Metropolitan
King County Council recently increased the number of licensed treatment
slots to 3,150 in an effort to reduce the problem. A record 144
heroin-related deaths were reported in King County in 1998, and 108 were
reported last year.

Critics of methadone treatment say it is only substituting one drug for
another. But addiction experts say it enables patients to hold a job,
support their families and live a normal life. Studies have shown drops in
crime and other medical services as a result of methadone programs. And
health officials say the treatment helps stop the spread of HIV, hepatitis
and other infectious diseases through the sharing of contaminated needles.

The Harborview project is the first to receive permanent waivers of
stringent federal regulations for methadone programs from the Food and Drug
Administration and the Drug Enforcement Administration. Other medical
centers have been allowed only experimental programs.

Traditional programs require most recovering addicts to get their methadone
doses daily - or in some cases, weekly - at a specialized clinic such as
Evergreen. They must receive counseling and be tested for drug abuse at
least once a week.

Under the Harborview program, addicts will receive doses for a full month
and be counseled and tested once a month. They also will be subject to spot
testing and checking of their supply of doses, to make sure they are staying
on the prescribed schedule. And they will be monitored for alcohol use and
criminal activity.

"They can go about their lives with a little more freedom. It's another step
in their recovery," Merrill said. "These are really highly functional people
coming into the program."

Merrill said the project will start with 10 patients. None has had any
lapses in drug use for at least eight years. Within the next few months, the
program will have 30 patients.

Ten Harborview physicians, who have received extra training for the project,
will serve as primary-care doctors for the patients. Some patients may
continue seeing Evergreen counselors they have worked with for years,
Merrill said.

The project at the Seattle hospital reflects a shifting philosophy among
many experts that favors greater freedom for stabilized, recovering heroin
addicts by distributing methadone through primary-care physicians.

A bill in the state Legislature would establish a pilot program allowing
private physicians to prescribe methadone. It also would remove limits on
the number of clients per treatment facility.