STATE NEEDS TO CLAMP DOWN ON METHADONE

The good news is, an administrative law judge has ruled in favor of Johnson
City in its legal battle to keep a methadone clinic from opening in the
city. The bad news is the ruling by Judge Hornsby - welcome as it is -
likely only delays the inevitable.

The Tennessee Health Services and Development Agency granted a certificate
of need to the Johnson City Addiction Research and Treatment Center with an
8-0-1 vote in June of 2002. But Judge Hornsby vacated that certificate of
need, citing the lack of a quorum. The methadone clinic and the THSDA have
until May 20 to file a written appeal or petition for reconsideration.
Whether such an appeal is made has little consequence. The owners of the
methadone clinic can simply reapply for a new certificate of need.

The prospect of a methadone clinic in Johnson City - like one proposed in
Kingsport a few years ago - has had the medical community up in arms for
more than a year. And no wonder. As many physicians have concluded, when it
comes to detoxing drug addicts, methadone's cure is illusory at best.

Designed to wean addicts off heroin, methadone and the clinics that
dispense it have sparked a great deal of concern in the Tri-Cities,
particularly in the last few years. The outcry produced a bill in 1998 that
gave local governments a veto over the location of new clinics. But the
legislation wasn't constitutional. The regulation of methadone clinics has
since been judged a state responsibility, meaning local governments don't
have a voice in the matter. That's why, no matter how much residents of
Johnson City object, a certificate of need is eventually likely to be granted.

New rules were developed in 1999 to regulate methadone clinics. But they
aren't much of a hurdle for addicts or the clinics who depend on them to
make money. All patients have to register with the state. This is supposed
to ensure that a patient isn't using the services of more than one clinic
at a time. But then again, are the records being reliably cross-checked?

Random drug testing of patients has also been mandated to make sure addicts
aren't using drugs other than methadone. But if the state were genuinely
interested in catching violators, it would demand testing of all addicts on
a basis so frequent that no one would have a chance to escape the drug
screening.

There are approximately 2,000 addicts in Tennessee receiving methadone
"treatment." Methadone is a highly addictive Schedule II drug, which places
it in the same category as morphine and other potent painkillers and
opiates. Methadone treatment, therefore, doesn't cure or rehabilitate a
drug addict, but merely steers him from being addicted from one drug to
another.

For all the time, professional attention and money that have been lavished
on heroin addicts in Tennessee, for all the years that methadone has been
dispensed, there are no state statistics on the effectiveness of the
program. Why?

The reason has to do with money.

Since methadone treatment moved out of carefully monitored, intensive
hospital settings into for-profit clinics, there is no economic incentive
to terminate treatment. The dirty little secret is that, in Tennessee, as
in most states, most methadone patients continue treatment indefinitely.

It wasn't supposed to be that way. Methadone was introduced a generation
ago as a means to an end, a way to wean hardcore heroin addicts away from
their addiction and eventually to reintroduce them into society as useful,
working, drug-free citizens. Methadone was envisioned as something which
would eventually fall into disuse. Instead, it has become an alternate
addiction not only for its patients, but the clinics that have come to
depend on the profits.

If the state has responsibility for regulating methadone clinics, the
legislature needs to radically change the rules under which methadone is
distributed. A good start would be to bring methadone treatment under the
TennCare system, which means only physicians could dispense the drug.
Weekly drug screenings would catch users of other drugs who would be turned
over for criminal prosecution. Physicians would be required by the state to
eventually wean all patients from methadone at a date certain.

Drug addiction is a terrible thing. But we do no kindness to addicts by
allowing for-profit clinics to prey upon them in the name of compassion
while the taxpayer picks up the tab into perpetuity.

State lawmakers need to address this situation. They ought to ensure that
methadone's use be as regulated as it is rare.