SAVING US FROM A CURE FOR DRUG ABUSE

Anyone with a broken ankle is grateful for the invention of crutches, and
anyone who loathes mice is likely to look favorably upon mousetraps. Those
suffering from a problem normally welcome a solution. But heroin addiction
is different. In this country, government bodies that claim to want to stamp
out this scourge actually seem more determined to get rid of the cure.

Physicians know how to treat heroin addiction: with a medicine called
methadone which, when administered once a day, satisfies the user's cravings
while allowing him to function normally. A 1990 report by the Institute of
Medicine at the National Academy of Sciences found that of all the drug
treatments known to man, "methadone maintenance has been the most rigorously
studied and has yielded the most incontrovertibly positive results."

What sort of positive results? Just stuff like reducing drug use, crime and
disease among addicts, while boosting their ability to hold jobs and stay
off welfare. Methadone, says Mark Kleiman, a professor of public policy at
UCLA, "is a real magic bullet." It can be safely used for decades.

But the only people treated with more suspicion by our laws than people who
use heroin are people who want to help them stop using heroin. Methadone is
supervised like the gold in Ft. Knox, subject to rules stricter than those
for any other pharmaceutical drug.

Addicts can't get it from their doctors--they have to go to special clinics,
which are burdened with an array of regulations on staffing, security and so
on. And since these clinics attract--surprise!--heroin addicts, not many
neighborhoods greet them with brass bands. New York Mayor Rudy Giuliani
wants to get the city entirely out of the business of dispensing methadone,
insisting that users should be able to abstain from heroin without relying
on another drug.

Given the resistance, methadone clinics are scarce, and they tend to be in
seedy urban areas far away from, and uninviting to, many middle-class users.
The main achievement of these policies is to prevent addicts from getting
help. For each one in treatment, experts say, there are another two or three
who would get it if they could.

Hard-line drug warriors generally have no use for methadone. They complain
that it merely substitutes one opiate for another--which is true and which
is like saying that nicotine patches are as bad as cigarettes. Yes,
methadone is a drug that many patients have to take for the rest of their
lives to stay clean. But plenty of people take medications every day to
alleviate ailments, from insulin to Prozac, without being verbally abused by
Rudy Giuliani. Some heroin users can kick the habit without methadone. But
that's no reason to abandon the ones who can't.

Even drug czar Barry McCaffrey, whose views do not always converge with my
own, sees the wisdom of expanding methadone treatment. Not long ago, the
White House drug czar was making disparaging claims about the effects of the
Netherlands' tolerance of marijuana use, and I was suggesting that he
wouldn't know how to pour water out of a boot if the instructions were
written on the heel. But McCaffrey is not always impervious to evidence.
This week, he journeyed to Mayor Giuliani's fiefdom to argue that what we
need is not less methadone treatment but more.

He made an incontestable case, noting studies which find that among heroin
addicts receiving this medicine, good things happen. Heroin use typically
drops 69 percent, cocaine use by 48 percent and crime by 52 percent--while
full-time work rises by 24 percent. People who stop using heroin are also
less likely to get AIDS, hepatitis and other nasty diseases. Treatment costs
just $13 a day, and the government is likely to save far more than that for
every addict it weans off heroin.

What is clearly needed, as McCaffrey suggested, is for laws to stop getting
in the way of patients who need a safe and effective drug and doctors who
want to prescribe it for them. If addicts could get their medication from
ordinary physicians and ordinary pharmacies, they would be more likely to go
into treatment and more likely to succeed at it.

For government officials to rail against methadone is like a thirsty man
rejecting water--irrational, self-destructive and indicative that the brain
has shut down under stress. McCaffrey is trying to bring them to their
senses by arguing that heroin addiction should be viewed less as a sin to be
punished and more as a disease to be treated--preferably with the best means
available.

Giuliani rejects such advice, contending that when it comes to drug abuse,
McCaffrey has "surrendered." The mayor, of course, is right. The drug czar
has surrendered to facts and reason--unlike Giuliani, who is still fighting
them.

Checked-by: Don Beck