OPEN FORUM -- ANOTHER LOOK AT METHADONE MAINTENANCE

LAST WEEK, Supervisor Gavin Newsom called for changing federal regulations
to endorse private physicans' prescribing of methadone to heroin addicts.

Newsom is right for many reasons. Endorsing private physician prescription
and pharmacy dispensation would allow patients stabilized on methadone to
leave the clinic setting, thus freeing up slots for addicts closer to the
street who may need more supervision initially. Treatment by private
physicians would be cheaper, and would allow patients to lead more normal
lives.

Citing increased overdose deaths and long waiting lists for treatment,
Newsom wants to `start looking at the problem as a medical one.` It's about
time. Today, less than 20 percent of the nation's heroin addicts are
enrolled in methadone maintenance, largely because programs are mired in
red tape and regulations, or are inaccessible because of cost or location.

In the late 1960s, after working with heroin addicts, Drs. Vincent Dole and
Marie Nyswander argued that addiction was a physiological disease.
Methadone, it was found, could lessen the physical craving for heroin, and
its daily use would enable a patient to stop using heroin and become a
productive member of society. According to Dr. Robert Newman of Beth Israel
Hospital in New York, the media heralded methadone as a ``Cinderella drug''
that could be economically applied to hundreds of thousands of addicts,
and, in short order, solve the narcotics problem.`

Methadone maintenance was and still is defined as a medical solution to
addiction, analogous to daily insulin for diabetics. The Nixon
administration adopted maintenance treatment as part of its arsenal in the
war on crime and drugs. Federally funded researchers produced mounds of
data showing that addicts on methadone maintenance treatment were able,
somefor the first time, to begin living without hard street drug use and
criminal pursuits. Methadone maintenance treatment worked, and the number
of patients on it increased rapidly in the early 1970s.

With methadone's growth, however, came calls to control its distribution.
Regulations stipulated that methadone, a synthetic narcotic, could be
dispensed only in licensed clinics on specific days and hours; the rules
also mandated random supervised urine testing and counseling. Patients
found that complying with the program often did not facilitate -- but
instead interfered -- with work, school, and family responsibilities.

In the 1980s, scientists determined that shared IV needles help spread the
AIDS virus. Nonetheless, addicts' access to oral methadone, which can
eliminate the need to use needles, was diminished even further during that
decade. Rea gan's fiscal austerity (toward the poor) meant a 30 percent
decline in funding for maintenance programs between 1976 and 1987.
``Treatment on demand'' became anything but a reality, particularly for
those who could not afford to pay clinic fees in excess of $300 per month.

Just when it is needed most as a treatment to help prevent AIDS, methadone
has become almost fully de-medicalized and inaccessible. Intravenous drug
use has now surpassed unsafe gay sex as the leading cause of new cases of
HIV disease. Study after study continues to show that methadone
maintenance, because it enables addicts to stop using needles, effectively
reduces drug related death, disease and crime.

Newsom was wise to call for expanding methadone treatment through increased
medicalization. That is, after all, where it has succeeded.