FEDERAL PROPOSAL WOULD PROVIDE METHADONE TO MORE DRUG ADDICTS

The White House's top drug official will announce Tuesday a policy to
expand the availability of methadone to all those who need it, despite
Mayor Rudolph W. Giuliani's criticism of the drug as simply exchanging one
addiction for another.

The official, Gen. Barry R. McCaffrey, is expected to outline a major
overhaul of Federal plans to treat heroin addiction in a speech Tuesday to
a national conference of the American Methadone Treatment Association in
Manhattan.

The plans to be presented by General McCaffrey, which incorporate ideas
from Government agencies and other specialists in substance abuse,
recommend that for the first time, doctors be allowed to administer
methadone to patients in the privacy of their offices. Methadone is now
dispensed at special clinics, at times that may make it difficult for some
recovering addicts to hold down jobs.

The new policy would make methadone treatment available to any addict who
requests and needs it. Methadone is used by 115,000 Americans addicted to
heroin and other opiates. They account for a fraction of the country's
estimated 810,000 opiate addicts, some of whom cannot find treatment giving
them access to methadone.

The policy is being announced at a time Mayor Giuliani has questioned the
need for methadone treatment. The Mayor has said he wants to end
government's role in providing the drug, a synthetic substance used to curb
the craving for heroin.

The Administration intends to redraft the Federal regulations governing
methadone in December or January. Officials said they doubted that
Congressional approval would be needed for the changes, and they foresaw no
barriers at the Federal level.

States have wide control over the availability of methadone, however. New
York State is the country's largest methadone provider, and Connecticut has
considered giving doctors a more central role in dispensing it. But eight
states -- New Hampshire, Vermont, West Virginia, Mississippi, North Dakota,
South Dakota, Montana and Idaho -- do not permit methadone clinics, forcing
residents who need it to travel to other states.

The hope is that a stronger endorsement of methadone's efficacy by the
Federal Government will encourage states to set up or expand methadone
programs.

Among other changes, the Food and Drug Administration would turn over the
regulation of methadone to the Substance Abuse and Mental Health Services
Administration. The plan also includes the creation of a comprehensive
evaluation and accreditation system to assess methadone treatment at
clinics, which vary widely in the quality and quantity of services.

Mayor Giuliani has sharply criticized methadone treatment, describing the
physical dependence it creates as tantamount to enslavement, and has
attacked General McCaffrey for endorsing it. Yesterday, the Mayor fired a
fresh broadside at the White House drug policy official.

"I guess General McCaffrey has surrendered," Giuliani told reporters, "and
essentially, what he'd like to do is deal with heroin addiction by making
people addicted to methadone, which maybe even is a worse addiction."

Medical experts have described methadone as the most effective treatment
available for heroin addiction, saying that it has been studied more
thoroughly than almost any other medication. A recent study by the National
Academy of Sciences called methadone "more likely to work than any other
therapy."

Mark A. R. Kleiman, a professor of public policy at the University of
California at Los Angeles, said in a telephone interview that the Federal
changes announced yesterday sound very much like the recommendations made
by the panel of specialists at the National Academy of Sciences.

"Everybody in the field agreed that the panel got it right," Professor
Kleiman said. "If what the panel said is going to be policy, I can only
say, 'Hurray.' "

Professor Kleiman added, "The devil's in the details, and I don't know the
details. But breaking methadone free of the shackles of the methadone
treatment system has to be the right thing to do."

During a visit to a methadone treatment center in lower Manhattan
yesterday, General McCaffrey once again declined to respond in like manner
to Mayor Giuliani, calling him "a great mayor" who had made New York City a
safer place to live.

But in an implicit reference to the Mayor's criticism, General McCaffrey
also cautioned against engaging in "shoot-from-the-lip policy analysis."

He added, "You've got to be cautious about the reality of 40,000 people" in
New York State who are enrolled in methadone maintenance programs.

General McCaffrey listened to addicts with first-hand experience with
methadone when he visited the Lower Eastside Service Center on East
Broadway yesterday. The center provides comprehensive methadone and other
drug treatment for 2,500 clients a year, said its president, Eileen Pencer.

Mark Adorno, who has taken methadone for six years, told General McCaffrey:
"It keeps me functional. I'm able to work and support my family. Without
it, I'd be sick."

Gina Neveloff, who takes methadone to stave off the heroin addiction she
acquired at 15, said, "For me, it puts some kind of sanity back in my life."

But Scott Riley, who said he became addicted as a soldier in Vietnam, said
methadone had not worked well for him and that he chose total abstinence, a
more difficult alternative that Mayor Giuliani favors and that General
McCaffrey also endorses.

General McCaffrey, who was badly wounded in Vietnam, appeared moved by the
stories he heard from the recovering addicts.

"In the Army, we give big medals to people who are heroes, and that's what
I think you are," he said.

Checked-by: Richard Lake