SAN FRANCISCO STUDIES PLAN TO LET PHYSICIANS PRESCRIBE METHADONE

SAN FRANCISCO -- Officials hope to make this the United States' first city
to allow private physicians to prescribe methadone to heroin addicts.

Saying their city is in the grips of a heroin epidemic, officials want to
lure more addicts into taking the replacement drug.

The Board of Supervisors asked the health department more than a year ago to
look into ways of expanding methadone treatment beyond the city's seven
methadone clinics. The department has drawn up a plan. Last week , the
federal Substance Abuse and Mental Health Services Administration said it
will fund a feasibility study of the program for the city.

"There is a growing heroin problem around the country and there are not
enough treatment slots to meet the needs," said Dr. H. Westley Clark,
director of the substance abuse administration. "Expanding treatment for
heroin addiction by the medical community is a promising approach that the
center believes is worthy of exploration."

City officials say they hope to complete their study and launch the program
within a year.

Under current federal law, methadone treatment is restricted to specialized,
closely monitored public and private clinics where the drug is dispensed,
usually daily, to patients who are registered in a treatment program.

Although methadone has been used in clinics for 30 years, it is still a
controversial treatment for addicts. Last year in New York, Mayor Rudolph
Giuliani launched a campaign against clinics, saying patients should be
steered into abstinence programs instead.

San Francisco's plan would allow addicts to be treated in the privacy of a
doctor's office and would possibly allow them to receive doses of methadone
at designated pharmacies. It could be implemented only if the city received
permission from both state and federal agencies that now register methadone
clinics.

Under current federal law, it is illegal for any doctor to prescribe
methadone. San Francisco would probably have to register its program as an
experimental program to receive an exemption from the law.

Methadone does not cure heroin addicts, but it can help them stay healthy
and functional and is often used for years.

"A heroin addict's life is out of control," said Alice Gleghorn, research
manager for the city's Community Substance Abuse Services. "Methadone
reduces heroin use, reduces addiction to this drug and stabilizes other
aspects of an addict's life. There are many people who are on methadone, and
none of their close associates know it."

A synthetic narcotic developed in Germany during World War II as a
painkiller, methadone -- which is given to addicts in liquid form -- staves
off withdrawal sickness without making patients high. It is more potent than
morphine with a longer duration of action and milder withdrawal symptoms.

For years, San Francisco has ranked third -- after Baltimore and Newark,
N.J. -- in per capita heroin-related hospital admissions. Health department
officials estimate there as many as 15,000 addicts in this city of 750,000.
About 3,000 heroin addicts are currently being treated in the city's
methadone clinics, and 400 addicts are wait-listed for the clinics.

In February 1998, county supervisors asked the health department to
establish a task force of physicians, addicts, clinicians and state and
local officials who deal with substance abuse issues to study ways of
expanding methadone treatment.

The group came up with a plan for the health department to train dozens of
physicians in methadone treatment for addicts.

Restricting methadone treatment to clinics, Gleghorn said, leaves too many
addicts untreated.

"There are many people who are not able to get to clinics, who are not able
to comply with the strict clinic structure or who are not comfortable going
for privacy reasons," Gleghorn said.

"Our plan is designed for people who are not availing themselves of clinics.
We're talking about direct access."