Saturday, January 16, 1999

MAYOR RELENTS ON PLAN TO END METHADONE USE

Six months after saying he wanted to abolish New York City's methadone
treatment programs, Mayor Rudolph W. Giuliani has abandoned his plan to
move all 2,100 heroin addicts at city hospitals into abstinence programs,
conceding Friday that his idea was "maybe somewhat unrealistic."

The shift came after a five-month city experiment aimed at moving heroin
addicts into abstinence programs at the five public hospitals resulted in
few successes, city officials said yesterday.

Only 21 of the 2,100 addicts have given up methadone, the synthetic drug
widely prescribed to blunt the craving for heroin. Of those, five have
relapsed into heroin use, the officials said.

Giuliani emphasized that he would continue to vigorously promote drug-free
programs in the city, adding that he still believes local clinics rely too
heavily on methadone. But he said his consultations with drug treatment
experts had persuaded him not to eliminate methadone programs, which
researchers across the country have described as the best hope for the vast
majority of recovering heroin addicts.

"What I had proposed was doing away with it completely except for a very
short transitional period," said Giuliani in an interview yesterday. "That
turned out to be too frightening, too jarring and maybe somewhat unrealistic."

Those remarks were quickly applauded by state officials and drug experts
who had been stunned by the Mayor's plan and by his attacks on researchers
who embraced methadone programs. In August, Giuliani derided methadone
supporters as "a politically correct crowd." And in September, he called
Gen. Barry R. McCaffrey, the White House's drug policy chief, "a disaster."

But all the while, Giuliani and his officials were also moderating their
policy, acknowledging at press conferences and City Council hearings that
abstinence might not work for everyone. And on Thursday, Giuliani returned
to that theme yet again in his State of the City speech, pulling back from
his original proposal another degree.

"When I say that I want people off methadone and toward drug freedom, I
realize that there's going to be a certain percentage where that can't be
done but we've got to reverse the horrible situation we're in right now,"
Giuliani said in his speech.

"So how about making a deal?" he continued. "Instead of doing away with
methadone completely -- maybe this will calm everybody down -- suppose we
reverse the percentages.

"Suppose instead of 63 percent of the slots being for keeping people
chemically dependent, 63 percent of the slots were for programs that were
for drug freedom," he said. "And we'll reserve 10, 15, 20, whatever we have
to for methadone for those people who need to have a transition and for
those people where drug-free programs just can't work."

Dr. Luis R. Marcos, president of the city's Health and Hospitals
Corporation, which oversees the city hospitals that had changed their
treatment on the Mayor's orders, said the shift reflects a clearer
understanding of the patients who struggle to battle addiction.

While he had originally estimated that most addicts could move from
methadone to abstinence in three months, Dr. Marcos now says he would be
happy if 40 percent or 50 percent could make that transition over the next
year or two. And he acknowledged that many drug experts would characterize
even that estimate as optimistic.

"Frankly, after looking at the population that we treat in our public
hospitals, three months detox was not realistic," Dr. Marcos said in an
interview.

State officials say the public hospitals treat only about 6 percent of the
36,000 heroin addicts in methadone treatment programs in New York City; the
others receive treatment in clinics financed by the Federal and state
governments.

Giuliani can affect treatment only in the public hospitals, where the
average patient has been relying on methadone for nine years. About 30
percent have also abused alcohol and other drugs.

Seventy percent are unemployed and many suffer from mental illness and
medical problems, Dr. Marcos said.

Under traditional methadone programs, addicts can take the drug
indefinitely. Giuliani has argued that addicts on methadone simply
substitute one dependency for another and advocated gradually weaning all
addicts from methadone altogether after three months. He and his advisers
now acknowledge that is unrealistic, and the hospitals will now instead
simply encourage addicts to try abstinence.

Drug experts said yesterday that the Mayor's remarks would probably have
little impact on methadone patients in city hospitals because City Hall's
approach never stood a chance of success. They say that the Mayor is simply
acknowledging that reality.

Wendy Gibson, a spokeswoman for the State Office of Alcoholism and
Substance Abuse, which had opposed Giuliani's plan to abolish methadone,
said her office supported the city's policy shift.

"We're encouraged that the city understands that there are successes in all
types of treatment, including methadone," Ms. Gibson said yesterday.

And Don C. Des Jarlais, the director of research for the Chemical
Dependency Institute of Beth Israel Medical Center, echoed her sentiments,
calling the Mayor's remarks "tremendously encouraging."

"It shows a much more sophisticated understanding of the problem of
addiction," said Des Jarlais, an expert on heroin addiction. "It is
important to provide methadone maintenance for those people who really need
that treatment. But creating additional treatment options is likely to be
beneficial, to the extent that patients can make their own choices about
what treatment works for them."

Giuliani said he made his decision after reaching out to various drug
treatment experts, including Joseph A. Califano Jr., the former secretary
of the U.S. Department of Health, Education and Welfare who is now the
chairman of the National Center on Addiction and Substance Abuse at
Columbia University. And when those experts continued to express
reservations about eliminating methadone completely, he reassessed his
position.

"I met with people, listened to the debate, talked to Joe Califano,"
Giuliani said. "I really do listen and read what people say and write. And
there are times when I actually agree with them."