Pubdate: Sun, 25 Jul 1999
Source: Standard-Times (MA)
Copyright: 1999 The Standard-Times
Contact:  http://www.s-t.com/
Author:  Christopher S. Wren, New York Times News Service
Click on: http://www.mapinc.org/hr.htm
for current articles about Harm Reduction

CLINTON PROPOSES NEW METHADONE REGULATIONS

Dissatisfied with the system for dispensing methadone, the Clinton
administration on Thursday proposed creating a national accreditation of
methadone treatment centers as a way of holding them more accountable for
keeping addicts off heroin.

The administration further proposed that a way be devised to accredit
hospitals and doctors so that they could prescribe methadone, which may now
be dispensed only by the treatment clinics. The hope is that this would
expand access to treatment.

These two proposed regulations were among several offered by the White
House Office of National Drug Control Policy, which said it was acting to
strip methadone of its stigma as a heroin replacement and recast it as an
effective public health remedy.

The proposal calling for national accreditation of methadone centers, which
are now certified only by states or locally, would change the focus of the
900 or so clinics from record-keeping and enforcement of bureaucratic rules
to encouraging addicts to seek and stay in treatment.

Methadone users have long complained about the indignity of lining up daily
to drink a plastic cup of cherry-colored liquid methadone under supervision
and sometimes give a urine sample to prove that they are not secretly using
drugs. Clinics have also been criticized for not tailoring treatment to the
needs of the individual with a more comprehensive array of services, from
psychological counseling and remedial education to job training, that would
address the reasons why an addict might have used heroin in the first
place. The rule on their national accreditation would try to fill vacuums
like those by upgrading standards and offering the addict more options.

Yet another regulation would underscore the public health problem posed by
heroin addiction by shifting government oversight of drug treatment
programs to the Substance Abuse and Mental Health Services Administration,
an agency of the Department of Health and Human Services. At present, the
Food and Drug Administration is charged with enforcing rules that date back
nearly 30 years and seem more concerned with preventing addicts from
reselling methadone than with helping them stay off drugs.

"These improvements should improve the quality of methadone treatment and
make it more accessible so that more addicts stop abusing heroin and living
a criminal existence," retired Gen. Barry McCaffrey, director of the Office
of National Drug Control Policy, said in a statement announcing the new
regulations.

McCaffrey described the proposals as nothing less than "a fundamental shift
in the way we approach drug abuse in our nation." He said 180 clinics would
be evaluated over the next 18 months to determine the standards for
accreditation.

The proposals still have several hurdles to leap. Comments will be invited
for four months, followed by a formal public hearing before the Department
of Health and Human Services. The department will then produce the final
rules, expected early next year.

Dr. Robert Newman, the president of Continuum Health Partners, a consortium
of New York City hospitals that includes Beth Israel and St.
Luke's-Roosevelt, said he saw nothing in the proposals to suggest that they
would achieve the goal of providing drug treatment for everyone who needs it.

"I have never understood why this one medication alone among all the
medications in the American pharmacopeia should be singled out for
physicians to have special approval," Newman said. "Any doctor can
prescribe morphine for pain to any heroin addict. What they can't do is
prescribe methadone."

Joycelyn Woods, executive vice president of the National Alliance of
Methadone Advocates, said the proposals reflected what the government
should have done with methadone at the outset.

"It was never done right, because it was never thought of as medical
treatment," said Ms. Woods, who herself uses methadone.

"I'm looking forward to this as the beginning of the end of getting rid of
this awful system we have," she said.

An estimated 810,000 Americans are addicted to heroin. But only 179,000 are
enrolled in methadone clinics, according to the American Methadone
Treatment Association.

A perception persists that methadone is just a substitute drug for heroin.
Eight states -- Idaho, Mississippi, Montana, New Hampshire, North Dakota,
South Dakota, Vermont and West Virginia -- prohibit methadone, forcing
addicts there who want to get off heroin to commute to other states.

The proposed regulations would not stop the states from banning methadone.
But McCaffrey said that improving the standard of care would foster a
climate of greater acceptance. "Once this merges into the mainstream of
medical practice," he said, "the political viability of allowing methadone
will increase."
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MAP posted-by: Richard Lake