METHADONE TRADES ONE ADDICTION FOR ANOTHER

The Tennessee Health Facilities Commission must have a soft spot for drug
addicts. How else to explain the approval of a methadone clinic over the
objections of area health care professionals.

The clinic, to be located at 200 W. Fairview Ave., in Johnson City, will
offer methadone treatment for a projected 250 people in its first two years
of operation. The approval came despite opposition from a wide range of
organizations, including Frontier Health and the James H. Quillen College
of Medicine at East Tennessee State University.

"We didn't feel there was a need for this clinic" said Dr. Ronald D.
Franks, ETSU dean of medicine and vice president for health affairs at
ETSU. "Patients in the area are very well taken care of without methadone."

Dr. Franks is not alone in his opinion. Indeed, many physicians have
concluded, when it comes to detoxing drug addicts, methadone's cure is
mostly illusory.

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. So much for democracy in action.

New rules were developed in 1999 to regulate the 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, 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 was 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 nearly 2,000 addicts in Tennessee receiving methadone treatment
but that term is deceptively benign. Fact is, 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 comprehensive 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, crime-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.

But the very basis for the program seems ridiculous. Imagine taking a
similar approach to another so-called "illness," that being alcoholism.
Why, we would see "clinics" dispensing alcohol to those "infected."

If the state health commission is going to disregard the considered
opinions of local health professionals as it has in the Johnson City case,
then the legislature obviously needs to revisit this issue with an eye
toward radically changing 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. And the program should
be designed to in some way have an ending point so that addicts don't get
their weekly high forever. 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.

The legislature needs to address this situation as soon as possible. When
it does, it ought to ensure that methadone's use be rarely used and
rigorously regulated. Methadone treatment should be a means to an end, not
an end in itself.