METHADONE USERS DON'T DESERVE PUNISHMENT

To the Editor:

Your Jan. 2 front-page article on methadone treatment refers to the nearly
universal desire of patients to be able to live without medication. This is
a desire with which everyone can empathize, especially those who suffer
from any of the myriad other conditions that fall under the rubric "chronic
disease" and by definition defy cure.

In none of these cases is the inability to achieve a medication-free
therapeutic goal viewed as a failure of the drug or of those by whom or for
whom it is prescribed.

The conclusion to be drawn seems clear: Methadone must be made available
for every heroin addict willing to accept it, and as is true for any
chronic illness, treatment should continue as long as a serious threat is
known to be associated with withdrawal.

ROBERT G. NEWMAN, M.D. New York, Jan. 2, 1999

To the Editor:

Re "Days on Methadone, Bound by Its Lifeline" (front page, Jan. 2):

As a post-partum nurse I am concerned about the newborn babies of methadone
users. Some mothers seem to do well. The response of the baby after birth
to exposure to the drug in the womb is another matter.

Because of methadone's long-acting nature, babies born to mothers on the
drug have a more severe and protracted withdrawal than do babies born on
heroin or cocaine. The treatments for opiate withdrawal (tiny doses of
opium or sedatives) are less effective for methadone babies than for those
on the other abused drugs. Babies addicted to methadone seem to be in agony
for the first few months of their lives.

Can something be done for women of childbearing age who take methadone to
block their ability to reproduce?

PATRICIA K. EMERY Berwyn, Ill., Jan. 3, 1999

To the Editor:

A Jan. 2 front-page article on methadone maintenance neglects a critical
failure of the treatment.

Methadone does not completely block a patient's craving for heroin.
Required drug testing in methadone maintenance programs identifies those
who continue to use heroin and dispenses punishment in the form of
humiliation and daily pickups.

Why punish people who seek treatment for heroin use for using heroin? The
only significant differences between heroin and methadone are the length of
action (methadone stays in the body longer) and the legal status.

People who use methadone to help control their heroin use and to avoid
entrapment by the police should not be punished for seeking heroin. Heroin
and methadone should be dispensed in supportive settings on a monthly basis.

ROBERT L. COHEN, M.D. New York, Jan. 3, 1999

The writer is a former director of the Montefiore Rikers Island Health
Services.

To the Editor:

Methadone doesn't enslave addicts, but overregulated, underfinanced clinics
do (front page, Jan. 2).

Depressives can be dependent on antidepressants and suffer a return to
dysfunction if taken off medication.

As with methadone, these drugs can have withdrawal symptoms.

But depressives aren't enslaved by Prozac.

They are liberated from their illness by the drug and their access to it.

Why shouldn't methadone patients be treated similarly?

Physician-prescribing and pharmacy pickup make more sense than a
dehumanizing chemical probation that reduces the efficacy of the best
treatment we have for heroin addiction.

MAIA SZALAVITZ