METHADONE STILL DISTRUSTED DESPITE SUCCESS

NEW YORK -- In the late 1960s, a group of black militants paid a
visit to a Brooklyn clinic to discuss the new treatment it was
offering heroin addicts, a drug called methadone. They came armed
with bayonets.

"They were going to kill me," recalled Dr. Beny Primm, director of
the Addiction Research and Treatment Corp. "They thought I was part
of the white man's way of enslaving black folk, and one of the ways
they enslaved black folk was to put them on methadone."

Methadone's long struggle for acceptance has been a topic of
discussion again lately with the death Aug. 1 of Dr. Vincent Dole, a
founding father of its use as a treatment for addiction.

His passing came eight weeks after another force in the field of
heroin addiction, Beth Israel Medical Center, marked the 40th
anniversary of its methadone program, the first to apply the
treatment Dr. Dole and Dr. Marie Nyswander developed at Rockefeller University.

The mood of both events was largely celebratory. Study after study
has validated Dr. Dole's methods, and Beth Israel's methadone program
now serves 6,000 patients at 17 clinics, or about one in six of all
methadone patients in the city.

And yet, supporters of the medication also voiced a regret: Even
after four decades, methadone is mistrusted by the public, just as it
was in the days when militants were banging on Dr. Primm's door.

"That's been the frustration of my life for the past 35 years," said
Dr. Robert Newman, a longtime overseer of the methadone program at Beth Israel.

Today, the medication -- a liquid narcotic that eases heroin cravings
without getting patients high -- is still assailed by critics who say
it keeps patients in a drug-dependent limbo. Clinics face resistance
wherever they open. Public figures such as Howard Dean and Tom Cruise
have assailed methadone programs as morally flawed.

As recently as 1998, Rudolph Giuliani, then mayor of New York,
announced a plan to do away with methadone treatment in all city-run
clinics. The goal of every addict, he said, should be total abstinence.

The plan never got off the ground, but it illustrated how little the
debate about methadone has changed since Dr. Dole and Dr. Nyswander
began promoting the medication in 1964.

Drugs like heroin were then viewed predominantly as a criminal
problem rather than a medical one. Addicts were shunned, even at
hospitals, which rarely had beds for detoxification.

The suggestion that heroin users be switched to methadone, an equally
addictive narcotic, struck some as illogical.

Over time, though, methadone won some critics over because of its
ability to alleviate the symptoms that make addiction so crippling.
Once their dose is calibrated, people taking methadone do not
experience withdrawal symptoms or physical cravings for more
narcotics. The drug blocks the euphoric rush addicts get from injecting heroin.

Patients drink a dose in the morning and feel normal for the rest of the day.

In recent years, controversy has found methadone again -- this time
over its use as a painkiller. The number of fatal overdoses from the
drug has nearly quadrupled as more and more doctors prescribe
methadone in pill form as an alternative to drugs like OxyContin. In
2003, methadone was listed as a cause of 2,452 unintentional
poisoning deaths in the United States, up from 623 in 1999, according
to the National Center for Health Statistics.

A downside of methadone when used to fight heroin addiction is that
it works only as long as someone takes it, meaning that most patients
have to take it every day for the rest of their lives.