The Well Kept Secret of Methadone: It Works

NEW YORKMore than 30 years ago, Dr. Vincent Dole, a metabolic
specialist, and Dr. Marie Nyswander, a psychiatrist, sought to reverse a
worrisome rise in heroin addiction here.

Working at the Rockefeller Institute as Rockefeller University
was then called, the researchers sought to block the craving for heroin
by substituting an opioid painkiller developed by German chemists
during World War II.

More than three decades later, the synthetic analgesic they first
tested in 1964, methadone, is accepted as the closest thing to a heroin
cure. About 115,000 Americans take it regularly.

Yet by various estimates, only 5 percent to 20 percent of such
users stay on it for more than 10 years. Some find they no longer want
the medication. Others relapse into drug use. Many are put off by the
cumbersome, often petty bureaucracy that administers methadone
misleading rumors that methadone is ruinous to health; and an insidious
social stigma that, by equating methadone with illicit drugs, forces users
to hide the achievement of taking back their lives.

"Successful methadone users are invisible," said Dr. Edwin A.
Salsitz, director of the methadone medical maintenance program at
Beth Israel Medical Center here. "Methadone is always judged by the
failures."

One success story is James Maxwell. With his white beard and
twinkling blue eyes, Mr. Maxwell resembles the poster grandpa for a
bygone America. He confesses to having turned 80, brags about his
four grandsons, and remarks, "No granddaughtersvery
disappointing."

As the harddriving trumpet player Jimmie Maxwell, he toured
with Benny Goodman, performed in the bands of Lionel Hampton,
Duke Ellington and Gerry Mulligan, and worked for years as a studio
musician on major radio and television shows.

"I don't think I missed a day of practice in more than 60
years," he said.

But Mr. Maxwell has a darker story to tell. In the prime of his
career, heroin nearly killed him. He has stayed clean by taking
methadone every day for nearly 32 years.

His wife of 55 years has known, of course, but hardly anyone
elsenot his employers or his neighbors, or his best friend, a retired
federal drug agent. "Just for reasons of my career, I didn't talk about
it," he said.

In that he is hardly alone. Because of its association with
heroin, those benefiting most from methadone are least likely to risk
their careers or reputations by saying so.

The stigma surrounding methadone was analyzed by Herman
Joseph, a research sociologist who worked with Dr. Dole and Dr.
Nyswander. Even an innocent yawn, he reported, can jeopardize a
methadone user's job if the boss mistakes it as drowsiness induced by
methadone rather than routine fatigue.

Yet the extensive medical literature on methadone does not
contain a single report of methadone's failing to block the craving for
heroin. "The safety and efficacy of methadone in the treatment of
narcotic addiction have been documented more extensively than any
other medication in the pharmacopeia," said Dr. Robert Newman,
president of Beth Israel Medical Center.

REGULAR doses break the heroin user's wild swings between
euphoria and withdrawal by stabilizing the level of opiates in the
bloodstream. Dr. Nyswander's experience with relapses of detoxified
addicts persuaded her that they could not shake heroin without
substituting a less harmful narcotic.

"Marie was convinced that addiction was a disease and had to
be treated with pharmacotherapy," said Dr. Mary Jeanne Kreek, an
early colleague of Dr. Nyswander. Dr. Kreek now heads the Laboratory
of the Biology of Addictive Diseases at Rockefeller University.

When the first patients were given up to 80 milligrams of
methadone once a day in doubleblind studies lasting eight weeks, she
said, ''they began turning away from drug administration and getting on
with their lives."

Methadone is practical and effective, Dr. Kreek said, because it
can be taken by mouth, its effects are felt gradually and it wears off
slowly. Half of it remains in the body after 24 hours. Heroin's euphoric
rush lasts only minutes. Minor side effects of methadone, including
sweating, constipation and a reduced sex drive, tend to disappear.

Still, methadone has its skeptics, like Dr. Mitchell Rosenthal,
president of Phoenix House, whose treatment programs strive for total
abstinence. Because many addicts abuse multiple drugs and have
limited education and job skills, he said, ''they are not going to be
chemically fixed by giving them another drug."

Dr. Salsitz agreed: "Methadone can't give you a job, or good
manners or make you literate." But for healing the medical symptoms
of heroin addiction, he equates methadone with what insulin is for
diabetics and other medicines are for high blood pressure.