This past fall, New York City Mayor Rudolph Giuliani launched a
misguided plan to get methadone patients at city-run hospitals off the
drug, saying that methadone treatment merely swaps one drug addiction
- to heroin - for another.

His attack on methadone patients comes within a year of the landmark
National Institutes of Health Consensus Conference in which an expert
panel affirmed the positive outcomes of this approach to treatment and
recommended it's expansion. Barry MCaffrey, director of the Office of
National Drug Policy, swiftly and correctly countered the mayor with a
strong statement in far-reaching support of methadone maintenacne treatment.

Campaigns decrying maintenance are nothing new. They were the
foundation of state anti-narcotic laws in the decade before the
passage of the Harrison Act (1914) and subsequently of both state and
national laws in the following five decades. Along with the
anti-maintenance mentality came vilification fo the heroin addict,
denunciation of ambulatory treatment, limited access to institutional
care, and a designation of abstinence as the only acceptable goal for
treatment.

Several maintenance clinics (mostly dispensing morphine) arose after
the Harrison Act severely restricting physicians from prescribing
opiates to addicts. Some, like a short-lived one in New York City,
were hastily planned and suffered from administrative problems.
Others, like the one in Shreveport, La., were effective and were
supported not only by the medial profession but also by local
politicians and law enforcement officials. But federal authorities at
the newly formed Narcotics Bureau were overzealous and successful in
their pursuit of these clinics. The last one closed in 1923.

Not until the mid-1960's was maintenance successfully reintroduced.
This time, there were two advantages over the clinics of the early
1900's. One was the synthesis of methadone, a maintenance drug which
could be taken orally. The fact that it lasted about 24 hours made
the administration of the drug feasible in outpatient clinics. Second,
amnulatory treatment of addiction had become acceptable.

Although methadone maintenance is no panacea, it is the most widely
used treatment for heroin addiction. Currently there are 115,000
patients in programs across the nation. It is the most studied of all
the treatment approaches and has been shown to be a cost-effective
approach for reducing heroin use, crime, and the spread of HIV. Many
heroin addicts treated with maintenance drugs have successfully
stabilized their lives, engaged in productive work, and are members of
healthey and happy families.

Where do we go from here? To say "shame" to Giuliani and "cheers" to
McCaffrey promotes political conflict and public interest but misses
my point. Let's start with a crash course in dignity and human rights.
First and foremost, remember that no matter what the headlines say,
the important struggle is not betwen the mayor and drug czar. The
major struggle is beween the heroin addict and heroin addiction. To
the extent that many have found health and stability through
maintenance treatment, we must support their efforts.

Dr. David C. Lewis, a Brown UIniversith professor of medicine and
community healthe, directs the Bron University Center for Alcohol and
Addiction studies. He also is a project director of the new Physician
Leadership on National Drug Policy.