The Mayor's Crusade Against Methadone

Mayor Rudolph Giuliani's drive against methadone maintenance programs
for heroin addicts ignores the most authoritative medical advice and
could lead to more suffering among those struggling to control their
addiction.

The Giuliani administration cannot shut down most of the 36,000 state
and federally funded methadone treatment slots in New York City. But
Mr. Giuliani says he will end methadone maintenance for the limited
population that he can directly control -- the roughly 2,000 people in
public hospitals who receive the treatment. The new policy may also be
applied to addicted inmates in city jails.

Mayor Giuliani considers abstinence the more morally acceptable
approach to curing addiction.

He argues that methadone should be used, if at all, for no more than a
few months, and then only as part of an abstinence program.

Abstinence is a worthy goal, but medical experts say that
methadone-to-abstinence does not work for many heroin addicts. They
often need to take methadone for years at a time. Most scientists in
the field consider methadone to be a medical treatment for heroin
addiction, not a substitute dependency, as Mr. Giuliani insists.

Methadone does not generate the euphoria of an opiate but reduces
withdrawal symptoms and blunts an addict's craving for heroin. Addicts
in methadone maintenance programs have shown decreased drug use, lower
crime rates, better social functioning and reduced likelihood of
transmitting the AIDS and hepatitis viruses through
needle-sharing.

These outcomes have caused scientific panels convened by both the
National Institutes of Health and the Institute of Medicine at the
National Academy of Sciences to recommend expanding access to
methadone maintenance treatment around the country.

A review this year by the Federal Government's General Accounting
Office concluded that "research provides strong evidence to support
methadone maintenance as the most effective treatment for heroin addiction."

In addition, Gen. Barry McCaffrey, the nation's top official on drug
policy, objecting to Mayor Giuliani's arguments, has said that
methadone maintenance therapy should be made more widely available.

If Mr. Giuliani thinks he knows better, he should sponsor a
small-scale test to show that heroin addicts can be moved quickly to
abstinence. His moralistic opposition to methadone maintenance,
introduced without public debate or discussion, could deprive many
addicts of the medication they need to remain heroin-free -- without
helping to reduce the scourge of heroin use in New York City.

Checked-by: Rich O'Grady