U.S. PROPOSES RULES TO BETTER TREATMENT WITH METHADONE

Dissatisfied with the system for dispensing methadone, the Clinton
Administration yesterday proposed creating a national accreditation of
methadone treatment centers as a way of holding them more accountable for
keeping addicts off heroin.

The Administration further proposed that a way be devised to accredit
hospitals and doctors so that they could prescribe methadone, which may now
be dispensed only by the treatment clinics.

The hope is that this would expand access to treatment.

These two proposed regulations were among several offered by the White House
Office of National Drug Control Policy, which said it was acting to strip
methadone of its stigma as a heroin replacement and recast it as an
effective public health remedy.

The proposal calling for national accreditation of methadone centers, which
are now certified only by states or locally, would change the focus of the
900 or so clinics from record-keeping and enforcement of bureaucratic rules
to encouraging addicts to seek and stay in treatment.

Methadone users have long complained about the indignity of lining up daily
to drink a plastic cup of cherry-colored liquid methadone under supervision
and sometimes give a urine sample to prove that they are not secretly using
drugs. Clinics have also been criticized for not tailoring treatment to the
needs of the individual with a more comprehensive array of services, from
psychological counseling and remedial education to job training, that would
address the reasons why an addict might well have used heroin in the first
place. The rule on their national accreditation would try to fill vacuums
like those by upgrading standards and offering the addict more options.

Yet another regulation would underscore the public health problem posed by
heroin addiction by shifting Government oversight of drug treatment programs
to the Substance Abuse and Mental Health Services Administration, an agency
of the Department of Health and Human Services. At present, the Food and
Drug Administration is charged with enforcing rules that date back nearly 30
years and seem more concerned with preventing addicts from reselling
methadone than with helping them stay off drugs.

"These improvements should improve the quality of methadone treatment and
make it more accessible so that more addicts stop abusing heroin and living
a criminal existence," Gen. Barry R. McCaffrey, retired, Director of the
Office of National Drug Control Policy, said in a statement announcing the
new regulations.

General McCaffrey described the proposals as nothing less than "a
fundamental shift in the way we approach drug abuse in our nation." He said
180 clinics would be evaluated over the next 18 months to determine the
standards for accreditation.

The proposals still have several hurdles to leap.

Comments will be invited for four months, followed by a formal public
hearing before the Department of Health and Human Services. The department
will then produce the final rules, expected early next year.

Dr. Robert G. Newman, the president of Continuum Health Partners, a
consortium of New York hospitals that includes Beth Israel and St.
Luke's-Roosevelt, said he saw nothing in the proposals to suggest that they
would achieve the goal of providing drug treatment for everyone who needs
it.

"I have never understood why this one medication alone among all the
medications in the American pharmacopeia should be singled out for
physicians to have special approval," Dr. Newman said. "Any doctor can
prescribe morphine for pain to any heroin addict. What they can't do is
prescribe methadone."

Joycelyn Woods, executive vice president of the National Alliance of
Methadone Advocates, said the proposals reflected what the Government should
have done with methadone at the outset.

"It was never done right, because it was never thought of as medical
treatment," said Ms. Woods, who herself uses methadone.

"I'm looking forward to this as the beginning of the end of getting rid of
this awful system we have," she said.

An estimated 810,000 Americans are addicted to heroin. But only 179,000 are
enrolled in methadone clinics, according to the American Methadone Treatment
Association.

A perception persists that methadone is just a substitute drug for heroin.
Eight states -- Idaho, Mississippi, Montana, New Hampshire, North Dakota,
South Dakota, Vermont and West Virginia -- prohibit methadone, forcing
addicts there who want to get off heroin to commute to other states.

The proposed regulations would not stop the states from banning methadone.
But General McCaffrey said that improving the standard of care would foster
a climate of greater acceptance. "Once this merges into the mainstream of
medical practice," he said, "the political viability of allowing methadone
will increase."