ON DIGNITY, HUMAN RIGHTS, AND MISGUIDED CRITICS OF METHADONE TREATMENT

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.

Checked-by: Don Beck