S.F. PUSHES HEROIN FIGHT; WOULD WIDEN METHADONE PROGRAM

City Health Officials Back Move To Allow More Doctors To Prescribe Medication

San Francisco is pushing to become the first city in the nation to make
methadone treatment for heroin addicts widely available.

The plan would allow physicians to prescribe methadone, a federally
regulated synthetic narcotic drug currently available only through a
handful of specialized clinics in The City.

San Francisco public health officials, who with Supervisor Gavin Newsom are
leading the drive, say the change would make it more convenient for addicts
to get treatment for their substance abuse.

Currently, only 2,000 of the estimated 13,000 to 15,000 heroin users in The
City are enrolled in a methadone program, a treatment method that federal
studies have shown to be a highly effective way to help heroin addicts kick
the habit or at least function better in society.

Federal studies also have shown that addicts on methadone are less likely
to commit crimes and more likely to work than if they were still using heroin.

"We know that methadone works; that's incontrovertible. That's not even
part of the debate," Newsom said.

What is at the heart of the debate is how methadone should be distributed.
Currently, only nine clinics in The City dispense it. City officials say a
close look at federal drug-control statutes reveals that individual
physicians could do the same, with special permission.

What's missing, say backers of the plan, is an institutionalized framework
to make it work. The City's plan would permit physicians in both the
private and public sectors to prescribe methadone through the Health
Department, acting as an umbrella agency.

City To Seek Funding

The department would oversee training and help participating doctors
through the inevitable federal inspections. Additionally, The City would
help secure federal and state funding to help subsidize the treatment,
which can cost from $ 4,000 to $ 5,000 a year per patient.

Deputy health director Barbara Garcia, who oversees substance abuse
services, said federal authorities must sign off on the details of the
plan, but she is optimistic and hopes to see the program running within a year.

Small-Scale Programs

Only New York City, Baltimore and Connecticut have tried methadone programs
like the one San Francisco is contemplating, but on a smaller scale. The
program San Francisco is looking at would be much broader in scope by
enlisting physicians trained in administering methadone. Australia, New
Zealand, Canada and parts of Europe have incorporated physician-based
methadone treatment into their mainstream health care practices.

At a Board of Supervisors hearing Thursday, Tracey Helton, a recovering
heroin addict, said that in the past 18 months she's been clean because of
methadone and other treatments, but three of her friends have died from
heroin overdoses, and several others have faced serious health problems.

"I applaud the Board of Supervisors for trying to push this through and
have people with more access to methadone slots," said the 29-year-old San
Francisco resident. "I'd hate to think they died because they couldn't have
a slot to get methadone access."

High Addiction Rate

Heroin addiction is one of San Francisco's biggest health problems. The
City ranks third in the nation behind Baltimore and Newark, N.J., for the
highest rate of heroin-related hospital admissions.

On average, San Francisco hospitals see three heroin overdoses a day and
one heroin-related death every third day.

Garcia said The City has a waiting list for its methadone program. She and
other experts say that the most successful way to treat addicts is to have
services available on demand.

The current program falls short of that for several reasons: Not everyone
can afford it, and the limited number of clinics makes accessibility
difficult for the already hard-to-reach population.

Expanding the methadone clinic system, she said, is difficult because many
neighborhoods have opposed them. Giving individual physicians with
established practices the ability to prescribe the drug "could improve and
expand access," she said. They also could work more closely with addicts on
other problems, such as hepatitis and AIDS.

San Francisco already spends about $ 900,000 in local money on methadone
treatment. Garcia said another $ 4 million to $ 8 million would be needed
to serve another 1,000 people who couldn't afford treatment under the
proposed physician-based system.