Source: New York Times (NY)
Contact:  http://www.nytimes.com/
Pubdate: Tue, 18 Aug 1998

THE MAYOR'S CRUSADE AGAINST METHADONE

Mayor Rudolph Giuliani's drive against methadone maintenance programs for
heroin addicts ignores the most authoritative medical advice and could lead
to more suffering among those struggling to control their addiction.

The Giuliani administration cannot shut down most of the 36,000 state and
federally funded methadone treatment slots in New York City. But Mr.
Giuliani says he will end methadone maintenance for the limited population
that he can directly control -- the roughly 2,000 people in public
hospitals who receive the treatment. The new policy may also be applied to
addicted inmates in city jails.

Mayor Giuliani considers abstinence the more morally acceptable approach to
curing addiction.

He argues that methadone should be used, if at all, for no more than a few
months, and then only as part of an abstinence program. Abstinence is a
worthy goal, but medical experts say that methadone-to- abstinence does not
work for many heroin addicts.

They often need to take methadone for years at a time. Most scientists in
the field consider methadone to be a medical treatment for heroin
addiction, not a substitute dependency, as Mr. Giuliani insists.

Methadone does not generate the euphoria of an opiate but reduces
withdrawal symptoms and blunts an addict's craving for heroin.

Addicts in methadone maintenance programs have shown decreased drug use,
lower crime rates, better social functioning and reduced likelihood of
transmitting the AIDS and hepatitis viruses through needle-sharing.

These outcomes have caused scientific panels convened by both the National
Institutes of Health and the Institute of Medicine at the National Academy
of Sciences to recommend expanding access to methadone maintenance
treatment around the country.

A review this year by the Federal Government's General Accounting Office
concluded that "research provides strong evidence to support methadone
maintenance as the most effective treatment for heroin addiction."

In addition, Gen. Barry McCaffrey, the nation's top official on drug
policy, objecting to Mayor Giuliani's arguments, has said that methadone
maintenance therapy should be made more widely available.

If Mr. Giuliani thinks he knows better, he should sponsor a small-scale
test to show that heroin addicts can be moved quickly to abstinence. His
moralistic opposition to methadone maintenance, introduced without public
debate or discussion, could deprive many addicts of the medication they
need to remain heroin-free -- without helping to reduce the scourge of
heroin use in New York City.

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Checked-by: Joel W. Johnson