COUNTY MAY SWITCH FOCUS IN HEROIN FIGHT

TREATMENT WITH METHADONE WOULD BE EMPHASIZED OVER CURE THROUGH COUNSELING

The Tacoma-Pierce County Health Department has worked up plans for a radical
shift in its approach to heroin addiction.

Today, residents get a chance to weigh in on the merits of turning the focus
away from curing addicts and toward treating them more like diabetics -
people whose body chemistry has been altered to the point they need daily
medication to keep from getting sick.

The medicine is methadone - a withdrawal-stopping drug the health department
dispenses to about 450 clients at its two Tacoma sites.

That number could rise to 700 if the Board of Health supports the shift in

philosophy, proposed new evening hours and efforts to streamline the
program.

Streamlining would include replacing the program's registered nurses with
less expensive licensed practical nurses and not requiring clients to attend
as many counseling sessions.

Debate hinges on whether such moves amount to trimming fat or hacking
muscle.

During an open-mike period at last month's health board meeting, two
methadone clients and a nurse whose job is in jeopardy argued the changes
would destroy the program's ability to make a difference.

The nurse, Judy Dodge, said she plans to be back before the board today,
arguing against a strategy she describes as "dose and dash." Reason is on
her side, she said.

"There isn't any logic to cutting staffing and expanding hours and expanding
clientele," Dodge said.

The logic is that it will work, counters Amadeo Tiam, the public health
manager who oversees the department's $2.6 million-a-year substance abuse
programs. Point-by-point, here are his arguments:

* Cutting staffing: Replacing "overqualified" RNs with LPNs and eliminating
some positions outright will make the program leaner, Tiam said. The health
department estimates it can save about $80,000 a year from the staffing
changes alone. That - and other moves - will help the department move toward
making the program entirely self-sufficient, Tiam said.

* Expanding hours: Tiam said offering evening hours will make the clinic
available to more people. Ideally, these will be addicts with jobs who
either

can afford to pay the $12.50 daily per-patient cost or who have insurance
coverage. The department gets more money from "private-pay" patients because
Medicaid covers only part of the cost of care, he said.

In 1998, the health department spent $464,000 in local match money on the
programs. The remaining $2.1 million came from state and federal sources.

* Expanding clients: In addition to its hoped-for financial upside, Tiam
said more clients means fewer people whose addiction drives them to crime to
pay for their next fix. That is an effort that fits better with the mission
Dr. Federico Cruz-Uribe, the health director, has set for the department,
Tiam said: preventing communitywide problems, rather than treating
individuals.

The state still has to approve plans to increase to 700 clients without
hiring extra staff members. The state health department's Division of
Alcohol

and Substance Abuse has a limit of 50 patients per counselor. The health
department wants it to be 70-to-1 here.

The state has been encouraging, but the final approval is not in hand, Tiam
said.

Meanwhile, a program called Maternal Outpatient Management and Support - the
other branch of the health department's substance abuse program - is facing
relatively minor changes, said David Bischof, who is in the midst of
applying to stay on as its supervisor under a slightly different staffing
plan.

The health board must approve all the changes. No votes - just speeches -
are scheduled for today.