AN OVERDUE PRESCRIPTION FOR DRUG ADDICTS

Special to The Times

IN more than 20 years of practicing medicine, I've read dozens of articles
in the medical literature on how to recognize a drug addict. The trouble
is, not many suggest what to do when you find one.

Doctors find them every day. Or, more accurately, they find us. Some are
street addicts. Others are middle-class moms addicted to prescription
drugs. A few are dealers. They represent all classes, races and
backgrounds. About the only thing they have in common is their addiction.

These people come to me and to other doctors with clever scams for getting
prescriptions for the drugs they want. I warn them of the dangers, but
addiction overwhelms common sense, even self-preservation. If I give them
what they want, they will only return for more. If I prescribe
inappropriately, I face audit by state authorities and revocation of my
medical license. And so, I regularly turn them away.

But this solves nothing. They move on, perhaps to another doctor, but their
problem - our problem - continues.

This is the reality and the shame of the way we treat (actually, fail to
treat) drug addiction in King County. It is a shame because there is a
better way - a proven, cost-effective way to deal with addiction to opiate
drugs such as heroin, morphine and hydrocodone.

The answer is drug-replacement therapy - the oral administration of drugs
such as methadone. This treatment, which includes support services and
counseling, works so well that it is widely accepted throughout the medical
community. Numerous studies have shown that it significantly reduces
illicit drug use.

With drug-replacement therapy, an addict's cravings are reduced, but they
do not get "high." They remain able to function in society, even to hold
productive jobs. In fact, communities that treat large numbers of opiate
addicts with methadone have experienced significant reductions in property
crime, drug pushing and the spread of HIV associated with drug use.

Unfortunately, under current government regulations, office-based
physicians cannot prescribe methadone. And in King County, there are only a
handful of methadone-treatment centers. Waiting lists are typically several
months long.

The legal system, too, is hamstrung by inadequate addiction-treatment
capacity. Prosecutors and judges rightfully take pride in "drug courts,"
which send abusers to treatment instead of to jail, but most offenders wind
up in non-methadone treatment programs, where relapse rates exceed 90
percent.

And so, thousands of people remain hopelessly trapped by their addiction
because the most effective treatment simply isn't allowed to be given.
Remember, for the most part, these are not people who have chosen drug
dealing as a profession. They might be your neighbor, your friend or
colleague. They seek treatment because they want off drugs.

To deal effectively with opiate addiction, both the medical and
law-enforcement communities need ready access to methadone treatment.
Addicts should be evaluated by specialists and treated within hours or
days, not weeks or months. What is preventing this?

While federal and state restrictions are burdensome, they aren't
insurmountable. Many addiction experts I've spoken with agree that the most
serious problem is at the county-government level. The number of
methadone-treatment facilities is fixed by the King County Council at five
centers, each of which is limited to treating 350 patients. That's just
1,750 treatment slots for an estimated 20,000 drug addicts.

The reason some officials give for regulating methadone in this way is to
prevent diversion of narcotics from the medical system to the streets - a
kind of "get tough on drugs" stance that, like so much of the war on drugs,
is based more on fear than fact. There is no evidence - none - that illegal
drug use is curbed by zealous restrictions on methadone treatment.

Methadone is not (and never has been) an attractive street drug. Street
addicts who use methadone do so to treat themselves for drug withdrawal - a
fact that infuriates drug pushers because it reduces demand for their
expensive, illicit drugs.

That's why the nation's "drug czar," Gen. Barry McCaffrey; the National
Institutes of Health and the National Institute of Medicine have all
recently endorsed the expansion of methadone treatment. The Washington
State Medical Association, the Washington State Pharmacy Association, the
King County Medical Society, the King County Prosecutor's Office and the
Seattle-King County Department of Health are also on record in support of
additional methadone treatment.

We could strike a major blow against drug addiction and abuse in King
County with three simple steps.

- -- First, allow practicing physicians to prescribe methadone to addicts who
have been accepted by a treatment program but have been placed on a waiting
list.

- -- Second, let existing drug-treatment centers that use other
addiction-treatment therapies prescribe methadone to treat opiate addiction.

- -- Third, allow office-based addiction specialists to prescribe methadone
to patients who have successfully completed drug-treatment programs.

Every citizen and every business in King County has a vested interest in
reducing drug addiction and the crime it generates. Along with the medical
community, the prosecutor's office and department of health, we should all
send a message to King County Executive Ron Sims and to members of the
County Council: It is time to vastly expand methadone treatment for those
who want so badly to control their addiction and to resume productive lives.