MCCAFFREY RELENTS ON MERITS OF METHADONE

In the endless, unwinnable war on drugs, the generals have relied on
rhetoric, not on scientific research. Propaganda has beaten pragmatism in
every battle.

Until now. Last week, Gen. Barry McCaffrey, the nation's drug policy chief,
called for expanding heroin addicts' access to methadone, in response to a
National Academy of Sciences panel that concluded methadone is "more likely
to work than any other therapy" for heroin addiction.

According to a federal study, methadone maintenance cuts addicts' heroin use
by 70 percent and criminal activity by 57 percent, while boosting full-time
employment by 24 percent. By reducing hypodermic use, it also lowers the
rate of HIV and hepatitis infections.

Since the '60s, special clinics have weaned addicts from heroin and other
opiates to methadone, a synthetic drug that suppresses drug cravings.

In a speech to the American Methadone Treatment Association, McCaffrey
echoed the recommendations of medical experts convened by the academy and
the National Institutes of Health, who have endorsed the effectiveness of
methadone treatment and criticized the government's heavy-handed regulation.

McCaffrey said patients should be able to get methadone at the offices of
specially certified doctors. Anyone who needs it should be able to get it,
he said.

Only 15 percent of heroin and opiate addicts - about 115,000 Americans - use
methadone now. There are waiting list at every methadone clinic in the
country. Eight states ban methadone clinics. Some patients must travel for
hours to drink a daily dose under a clinic monitor's supervision, making it
difficult to hold down a job.

Methadone treatment is much more widely used in European countries. But in
the United States, substance abuse has been treated as a sin, not as a
disease, and the zero-tolerance zealots will settle for nothing less than
abstinence.

Methadone is crutch, not a cure for drug dependency. While some addicts use
methadone as a steppingstone to a drug-free life, others remain on methadone
maintenance for many years.

But because the drug doesn't create euphoria or sedation, users can work,
raise families and rebuild their lives. "At proper doses, methadone lets
addicts function normally, without making them 'high,' and can be safely
consumed for decades with remarkably few bad side effects," wrote Ethan
Nadelmann and Jennifer McNeely in Public Interest in 1996. "Methadone is to
heroin users what nicotine skin patches are to tobacco smokers."

Expanding methadone treatment doesn't just offer heroin addicts a way off
the streets. It makes the streets safer for everyone else.

"Current policy ... puts too much emphasis on protecting society from
methadone, and not enough on protecting society from the epidemics of
addiction, violence and infectious diseases that methadone can help reduce,"
concluded an Institute of Medicine committee in 1995.

Federal, state and local regulations limit doctors' authority to decide the
best way to provide methadone, the most effective dose and the right time to
move patients off the drug.

Regulations limit flexibility, require useless paperwork and impose
unnecessary costs, concluded an NIH panel last year, which was charged with
reporting on the medical and scientific consensus on methadone. "Yet these
regulations seem to have little if any effect on quality" of care. "We know
of no other area where the federal government intrudes so deeply and
coercively into the practice of medicine."

Drug enforcement agents fear methadone will be abused, but the researchers
say most street sales are to addicts who can't get into a methadone
treatment program. "The problem isn't that there are too many methadone
programs; it is that there are too few," said Gen. McCaffrey.

Of course, the drug czar isn't listening to scientific and medical experts'
conclusions on needle-exchange programs and medicinal marijuana. But perhaps
this is a first step toward sanity in the nation's drug policy.

Checked-by: Don Beck