Response

CRITICISM OF METHADONE, CLINIC INACCURATE

In the Dec. 31 letter, "Health experts', residents' opposition valid," by
D.E. "Ed" Andersen, I have difficulty in letting the writer get away with
some of his comments, especially since he is a colleague and should know
better.

First, the writer often referred to the Food and Drug Administration, but
FDA no longer has any regulatory oversight to opioid treatment programs. We
are under the Center for Substance Abuse Treatment, which is part of
Substance Abuse and Mental Health Services Administration, which, in turn,
is part of the U.S. Department of Health and Human Services.

Second (contrary to the writer), we are an outpatient program; we offer
similar services as [Andersen's] Shoreline Behavioral Health Services
offers: individual, family and group counseling. But since we are a medical
model of treatment (pharmacotherapy), we also provide medication to
alleviate opiate withdrawal symptoms as well as drug cravings. This makes
it possible for the opioid~dependent patient to benefit more from the
clinical services.

The writer also asserts there was no need for a methadone clinic in Horry
County. On what basis? For an opioid treatment program to get a license to
operate, it must receive a Certificate of Need from the S.C. Department of
Health and Environmental Control. If a need cannot be substantiated, then a
certificate is not granted.

In the case of Horry County, far too many of its citizens had to travel
hundreds of miles a week to receive treatment that formerly was not
available in their own county. Additionally, every research study conducted
over the past 40 years demonstrates that the most effective treatment
modality for treating opioid dependence is the combination of opioid
replacement medications (pharmacotherapy) and addiction counseling. The
research also indicates medical detoxification followed by outpatient
counseling (which the writer advocates as a more effective alternative to
opioid treatment programs) is only slightly more effective than just going
cold turkey. The Office of National Drug Control Policy has stated that one
of its goals for 2004 is to expand "opiate substitution treatment training
efforts."

The writer states there are "valid reasons" that the U.S. Drug Enforcement
Administration "requires an evaluation of the availability of local police
or security personnel," but he never gives the "reasons." Well, that is
because his information is wrong. We are not required to evaluate
availability of local police, nor are security personnel required. Like any
pharmacy that houses Schedule Two narcotics, we are required to have a
security system in place and a method of accurate accountability of the
Schedule Two drug.

The writer also writes "there are valid reasons for the FDA (should read
"CSAT") to insist that ... patients have access to emergency
psychiatric/medical services, etc." Our programs do have referral networks
linking with other health care professionals; but that is simply
best-practice policy for any substance abuse program, including Shoreline.

He was right about one paragraph. The Center for Substance Abuse Treatment
and DHEC do allow the program physician to grant patients take-home
medications. The patient must meet criteria [showing he or she] is stable
and responsible in the care of the medication.

Finally, the writer's last paragraph gives the greatest evidence of his
lack of understanding of the neurobiology of opiate addiction and the
evidence-based effectiveness of opioid treatment programs. Methadone has
been researched for nearly 40 years. The evidence is overwhelming in the
conclusion that it is the best treatment available for opiate addiction.

The writer, of Greenville, is president of the S.C. Association for the
Treatment of Opioid Dependence.