GIULIANI ORDERS 5 CITY HOSPITALS TO WEAN ADDICTS OFF METHADONE

NEW YORK -- Following through on his promise to overhaul drug treatment in New
York City, Mayor Rudolph Giuliani has decided that heroin addicts treated at
city hospitals will generally be allowed to get methadone for no more than
three months, city health officials Friday.

The policy change, which will take place in about 60 days, will affect 2,000
addicts who take methadone, a synthetic drug that has been widely
prescribed to
blunt heroin cravings for the last 30 years. Under the new plan, addicts
enrolled in programs at five city hospitals will be weaned from methadone
within three months, instead of taking it indefinitely as they do now. The
programs will continue to offer intensive counseling and other services after
that time.

The mayor has argued that methadone maintenance programs simply substitute one
dependency for another, and that abstinence from drugs is a more moral and
decent approach to curing addiction.

In preparation for the shift, city officials suspended admissions this week to
the methadone programs at Bellevue, Harlem Hospital, Metropolitan Hospital,
Elmhurst and Kings County. The hospitals, which each typically receive about
four new patients weekly, began referring those clients to other private and
state-run clinics, city officials said.

The decision immediately created a furor in the drug-treatment community,
where
methadone treatment has been embraced by the National Institutes of Health;
Gen. Barry McCaffrey, the White House drug policy chief, and state drug
rehabilitation officials.

While city officials control less than 10 percent of the 36,000 methadone
treatment slots in New York City, state health officials said the policy shift
could create a shortage of desperately needed slots. The city's methadone
treatment system is already operating at more than 90 percent of capacity,
officials said.

State officials, who provide some of the financing for the city programs, said
they also feared for the health and well-being of the heroin addicts forced to
make the new transition. About 1,000 methadone-to-abstinence slots already
exist in New York City, but "historically, it has not worked for everybody,"
said Wendy Gibson, the spokesperson for the State Office of Alcoholism and
Substance Abuse.

State officials said they wanted to review the city's plan, but Dr. Luis
Marcos, president of the city's Health and Hospitals Corp., said the city had
the authority to make the decision on its own.

Marcos said the new policy will liberate heroin addicts from their dependency
on methadone, moving them to abstinence, very much like alcoholics. "We would
like to be able to free many of these men and women who are life-dependent on
this drug, which is a synthetic painkiller very similar to heroin," Marcos
said
in an interview.

"The expectation for the alcoholic is to be abstinent and the expectation for
the heroin addict should have the same goal. I believe that society has been
rather lax in terms of dealing with heroin addicts. It's very easy and
inexpensive to give a pill of methadone for life to people. But the time has
come to liberate these addicts from that kind of expectation."

Marcos said heroin addicts receiving treatment at city hospitals would also be
required to work as part of their recovery program, which is a plan widely
supported by most drug treatment experts. Hospital officials have already
begun
to evaluate the 2,000 methadone maintenance patients to assess their needs.

City officials said they were also re-evaluating methadone treatment for the
4,300 inmates at city jails. And Marcos said he expected some consternation
among drug treatment officials as the city moves to dismantle a treatment
regimen that has been widely considered the best hope for heroin addicts.

"I know change is not easy, and their reaction is the normal expected reaction
of people who are being challenged to do things differently," Marcos said. "No
matter what the change is, people react with fear and concern. But it is time
to re-evaluate. We're going to do it."

Copyright 1998 The New York Times

Checked-by: Ghamal de la Guardia