GIULIANI'S DRIVE AGAINST METHADONE CALLED UNLIKELY TO PREVAIL

NEW YORK -- As Mayor Rudolph Giuliani began a second day of attacks on
methadone treatment, many experts and government officials said that he
could, in reality, do very little to force a retreat from the synthetic
drug that has been widely prescribed for 30 years to blunt heroin cravings.

While roughly 40,000 heroin addicts receive methadone in New York City, the
mayor has no control -- financial or regulatory -- over the programs that
serve the vast majority of those addicts, experts say.

Dr. Luis Marcos, president of the city's Health and Hospitals Corp., said
the city was re-evaluating its drug treatment programs in the few places
where it has direct authority, in the city jails and public hospitals. And
even if the mayor's ability to act was limited, he seemed to relish
repeating his condemnation of methadone, which he first expressed Monday in
apparently impromptu remarks, saying its use simply replaced one addictive
drug with another.

He pushed aside criticism from many experts on addiction and fears from
former heroin addicts themselves and said abstinence was a more "moral" and
"decent" way to cure heroin addiction.

"I don't get offended any longer when people call me crazy," Giuliani said
at a news conference, responding to the attack from one doctor. "But I
wonder about a doctor running a methadone program who, when a mayor raises
the idea that we should end methadone, which is a way of keeping people
dependent, describes my idea as crazy."

Aside from the broad attacks on methadone, its cost and its supporters, the
mayor and other city officials did not elaborate on what exactly he might
do.

Marcos, who runs the public hospital system, said that his department has
already started to adjust the goals of its drug treatment programs, and
that abstinence would become the city's new measure for success in treating
heroin addiction, just as it is for treating alcoholism.

He said that if not enough former heroin addicts were also able to quit
taking methadone, the city could stop offering it in drug programs in
public hospitals and jails, where the treatment is partly paid for by the
state and federal governments.

"It could be that one day we decide to stop offering methadone because we
consider we are not helping people and it is not ethical to provide a
service just because we are getting reimbursed," Marcos said.

But the numbers of people in these city programs underscored just how
little control Giuliani has over most methadone programs around the city.
The city pays directly for just one methadone program, which serves 4,300
prisoners a year in the city jail system, accounting for a scant 10 percent
of those taking methadone in New York City. The city could withhold
methadone from those addicts.

The city also serves 2,000 more people in 5 drug treatment programs in
public hospitals, and could stop providing methadone there. But those
patients are paid for mostly with federal and state dollars and would be
free to join other private programs.

About 34,000 more people receive methadone in 122 private programs licensed
and regulated by the state, not the city. This year, all the programs,
except the one in the jails, were paid for largely by a combination of
$30.6 million in direct state money, and another $103.2 million in Medicaid
money, which is paid for from federal, state and local governments,
according to the state Department of Health.

Although New York City contributed $25.8 million in local Medicaid money,
state health officials said the mayor could not stop paying for methadone
because Medicaid regulations require that it be covered.

The city does not "have the option to tailor Medicaid benefits," said
Frances Tarlton, a spokeswoman for the state Health Department.

Several drug addiction experts accused the mayor of playing politics with
the issue of methadone and overlooking what they contend are the benefits
of the drug: people on methadone, they say, are less likely to commit
crimes or contract HIV and more likely to be employed.

"I'm extraordinarily surprised to find that any public high-ranking
official of either party does not know of the 30 years of scientific and
clinical research documenting the safety and effectiveness of methadone
maintenance treatment," Dr. Mary Jean Kreek, who helped develop methadone
in the 1960s, said in a telephone interview.

"To deny treatment would be turn people who are able to work back into
potential street criminals," added Dr. Kreek, who heads the Laboratory of
the Biology of Addictive Diseases at Rockefeller University in New York.

Joycelyn Woods, executive vice president of the National Alliance of
Methadone Advocates, who has been taking methadone for 25 years, said she
was afraid the mayor's comments might make it harder to get the drug she
says helped to rebuild her life.

"This is a lifesaving medicine," said Ms. Woods, who has earned a master's
degree since overcoming heroin addiction. "To have it taken from you like
this, and to see somebody like the mayor say it, is like a knife in your
heart."

But even if many addiction experts condemned Giuliani, several did not,
saying that methadone treatment does indeed cost too much, and that many
people stay on it for years and remain addicted to other drugs.

"I think the mayor, even though he may not have meant to get into this area
quite this way, is really on the right track in the sense of wanting to get
at that large number of people who are really stuck and not making
progress," said Dr. Mitchell Rosenthal, president of Phoenix House, a
network of treatment facilities that do not use methadone. "In that sense,
I think he may be making a real contribution to rethinking this aspect of
public policy."

Checked-by: (Joel W. Johnson)