METHADONE TURNABOUT IS A WELCOME FIRST STEP

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.

In addition to rewriting rules to ensure the quality of clinic-based
methadone treatment, McCaffrey said patients should be able to get
methadone at the offices of specially certified doctors. Anyone who
needs methadone 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 lists at every
methadone clinic in the country, said a recent study by a physicians'
group. 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
that make it available through doctors and pharmacies. But in the
U.S., 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 maintenance essentially is a 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.
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. ``Why, if methadone is effective, is it regulated
so highly and so differently from other drugs?''

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.

When Belgium allowed doctors to prescribe methadone, street sales fell
off.

New York Mayor Rudolph Giuliani wants to shut down methadone
treatment, forcing addicts to go cold turkey -- or go back to heroin.

``Methadone is a terrible, terrible perversion of drug treatment
because it leaves a person dependent,'' said Giuliani in a July 20
speech.

By that logic, diabetics should be forced to give up their dependency
on insulin.

McCaffrey said the mayor's views ``are at odds with the conclusions of
the nation's scientific and medical community. The problem isn't that
there are too many methadone programs; it is that there are too few.''

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.

Joanne Jacobs is a member of the Mercury News editorial board. Her
column appears on Mondays and Thursdays. You may reach her at 750
Ridder Park Dr., San Jose, CA 95190, by fax at 408-271-3792, or e-mail
to JJacobs@sjmercury.com .

1997 - 1998 Mercury Center.

Checked-by: Rich O'Grady