MAYOR STEPS UP HIS CRITICISM OF METHADONE PROGRAMS

NEW YORK -- One day after detailing his plan to wean 2,000 heroin addicts
off methadone at city hospitals, Mayor Rudolph Giuliani stepped up his
attack on methadone treatment programs Saturday, accusing them of enslaving
former drug users instead of pushing them toward abstinence.

Giuliani sharply criticized drug treatment experts -- like scientists at
the National Institutes of Health; Gen. Barry R. McCaffrey, the White House
drug policy chief; and state officials -- who say decades of research show
that methadone offers the best hope for the vast majority of recovering
heroin addicts.

Giuliani disputed their views Saturday, saying methadone maintenance
programs simply substitute one dependency for another, leaving thousands of
addicts tethered indefinitely to the synthetic drug widely prescribed to
blunt the craving for heroin.

And the mayor seemed to relish the opportunity to steer the city off the
traditional course and to portray himself as an innovative thinker who
cares more about the poor than the drug treatment specialists he assailed
Saturday as a "politically correct crowd."

"The critics and the advocates are just going to have to deal with the fact
that we have a different view on methadone than they do," Giuliani said. "I
think methadone is an enslaver. It's a chemical that's used to enslave people.

"If it's necessary for transition, then of course it should be used for
transition," he said. "If you're going to keep somebody permanently
enslaved to methadone for the rest of their lives, then I have real
questions about your common sense."

Under his new plan, which will begin in about 60 days, all addicts enrolled
in five city hospitals will be weaned from methadone within several months,
instead of taking it indefinitely as they do now. City officials said most
addicts would need only about three months to make the transition to
abstinence, although each patient would be evaluated individually.

But state officials, drug treatment specialists and even some providers who
run methadone-to-abstinence programs continued to raise concerns about the
mayor's plan, saying it goes too far by completely eliminating methadone
maintenance, which is desperately needed by thousands of addicts.

"I'm alarmed that the city is taking this approach," said Ray Diaz, a
senior vice president at Samaritan Village, a drug treatment program that
offers a methadone-to-abstinence program for 58 heroin addicts.

"This model doesn't work for everyone," Diaz said. "We need a number of
different treatment models at city hospitals. Methadone maintenance
programs are vital."

State officials and drug rehabilitation specialists emphasized that they
were not dismissing the value of methadone-to-abstinence programs. Of the
36,000 treatment slots for heroin addicts in New York City's public and
private clinics, about 1,000 are already devoted toward abstinence.

And Eileen Pencer, who runs such a methadone-to-abstinence residential
program for 90 addicts at the Lower East Side Service Center, said she
thought more heroin addicts would embrace the approach if additional beds
were available.

But Dr. Mary Jeanne Kreek, who heads the Laboratory of Biology of Addictive
Diseases at Rockefeller University in Manhattan, said drug research showed
that such methadone-to-abstinence programs can help only about 20 percent
of all heroin addicts.

"These programs have served an important role for a very limited number of
people," said Dr. Kreek, who has studied drug addiction for 30 years.
"Unfortunately, most of those people, between 70 and 90 percent, relapse to
illicit opiate use in one year."

Giuliani acknowledged Saturday that the new approach might not work for
everyone. But he said it was important to expand the availability of
methadone-to-abstinence programs so that addicts could choose for themselves.

Currently, he said, federal and state officials mistakenly spend most of
their dollars on methadone maintenance, making it difficult for drug users
to try anything else.

"Let's try it," Giuliani said of the new approach. "It is better to try to
have abstinence work for increasing numbers of people than having the
situation that these doctors have brought about. And the editorial board of
The (New York) Times I would include in the group that doesn't seem to
really understand what this is all about.

"The goal of our society should be self-reliant people -- not normalizing
dependency," he said. "What's happened is, the treatment of choice now
among all of these doctors is methadone -- 35,000 people in that kind of
treatment; only 15,000 people in other kinds of treatment."

As word of the mayor's plan trickled into the city's methadone clinics,
recovering addicts reacted with fear and approval. Steve, a 32-year-old
addict, who refused to give his last name, said, "People are in shock.

"You're going to be physically putting people into a position where they're
going to be sick, hurting, going on the street without methadone looking
for heroin," he said.

But another heroin addict, who declined to be identified, said he supported
the expansion of methadone-to-abstinence programs.

"If you are determined to clean up your life and not abuse drugs anymore,
it would be good for you," he said.

Copyright 1998 The New York Times

Checked-by: Mike Gogulski