NEW DRUG TREATMENT TACTIC PHYSICIAN-PRESCRIBED METHADONE
IS AN ANSWER FOR ADDICTS

Despite San Francisco's treatment-on-demand policy, which is lauded as
a national model, the fact remains that only a fraction of the city's
controlled-substance users -- including an estimated 13,000 to 15,000
heroin users -- are currently enrolled in some kind of treatment.

At any give time, San Francisco's wait list for treatment tops 400
people.

During the past two years, we've seen the tragic consequences of our
failure to provide immediate services to counter the growing epidemic
of heroin abuse: The high profile deaths of Nicholas Traina, the
19-year-old son of Danielle Steele, followed by Oscar Skaggs, the
21-year old-son of Boz Skaggs. The only possible good resulting from
this overpriced lesson was the recognition that heroin spreads across
a wide social strata.

San Francisco currently ranks among the top cities in the nation --
right behind Baltimore and Newark -- for the highest rate of
heroin-related hospital admissions. However, thanks to the hard work
of a group of physicians, heroin users, clinicians, policy experts,
and the city's Department of Public Health, San Francisco now stands
on the verge of becoming a national leader in the expansion of
treatment for addicts.

How will we do it? By allowing physicians to prescribe
methadone.

The Board of Supervisors' Public Health Committee has reviewed a plan
that will enable doctors to prescribe methadone, a highly regulated
medicine that is considered the most effective treatment for heroin
addiction.

This innovative plan is the outgrowth of a resolution passed nearly a
year ago by the board to develop a program that would significantly
expand access to methadone -- which is currently only available
through clinics.

San Francisco's plan is in line with a recent proposal by President
Clinton to expand access to treatment by having the government
accredit doctors and hospitals to prescribe methadone rather than
limiting that authority to clinics operating under state and local
control.

Clinton is doubtless acting on the advice of his drug policy adviser,
Gen. Barry McCaffrey, who, in turn was inspired by National Institute
of Drug Abuse research that found metha done treatment reduces heroin
use by 70 percent; criminal activity by 57 percent; and increases
full-time employment by 24 percent.

There are many benefits from this commonsense approach to drug
treatment.

Most notably, physician prescribed methadone will greatly increase the
number of treatment slots. Of the approximately 13,000 to 15,000
heroin users in San Francisco (out of an estimated 800,000
nationwide), only 2,500 are enrolled at one of San Francisco's six
methadone clinics.

When those not in treatment were asked if they would accept a
treatment slot if it were available tomorrow, 59 percent said yes.
Second, allowing general practitioners to dispense methadone would
offer patients a comprehensive one-stop approach to health care. Those
suffering from related illnesses such as HIV, Hepatitis C, soft-
tissue infections and asthma will have their special needs met. Third,
dispersing methadone patients throughout the city to private offices
will remove the stigma associated with public clinic treatment.

This not only can serve to lure patients who otherwise might not have
sought treatment, but also to dispel concerns from citizens who object
to methadone clinics in their neighborhoods. Physician-prescribed
methadone is not without its critics, however.

The most commonly voiced concern is that clients may engage in
diversion.

Diversion, the black marketing of methadone to heroin users for whom
it was not prescribed, has been recorded in low percentages in other
countries where methadone is available through physician prescription.
However, methadone, which blunts the craving for heroin, does not
produce the same high associated with heroin.

Second, if the physician-prescribed option is available to one user,
it would be similarly available through the proper channels to any
would-be black market purchaser.

But won't addicts just be exchanging one drug for another?

As noted above, methadone is not the drug of choice for most drug
addicts.

Yet, many addicts are only able to lead a healthy, productive
existence with the assistance of methadone. Given that methadone has
been proven effective at saving lives, isn't it time we took the bold
step of making it accessible?

Gavin Newsom is a member of the San Francisco Board of
Supervisors.