In a surprise addition to a speech on welfare this week (7-20) New York City Mayor Rudolph Giuliani announced a plan to "phase out and do away with methadone maintenance programs in the City of New York" over the next 2-4 years. There are currently around 35,000 people in New York City who are on methadone maintenance.
"Methadone is a terrible, terrible perversion of drug treatment because it leaves a person dependent," said Giuliani. But many others, including medical professionals, and even the Office of National Drug Control Policy, strongly disagree.
Joycelyn Woods, president of the National Association of Methadone Advocates, told The Week Online "Studies show that people who are administratively discharged from methadone programs (forced off due to pre-determined time limits) have a relapse rate of almost 90%. It is not like the people in these programs haven't tried other forms of treatment. Methadone is usually the last resort after numerous attempts. These people have years of failed treatment behind them. For them, methadone is the only thing that works."
Woods continued, "Of all of the issues involved in addiction and drug policy, methadone is one of the few with broad consensus. Even the Drug Czar's office is actively calling for increased access. By making methadone unavailable in New York, you're essentially telling tens of thousands of people that we would rather spend our time and money chasing you down and putting you in jail than allow you this medicine which is helping you to stabilize your life. You have to be an idiot to say what the Mayor said yesterday. He obviously has no idea what he's talking about."
And Woods was not alone in her criticism. "He said what?" said Dr. Don Des Jarlais, director of research for the Chemical Dependency Institute of Beth Israel Medical Center when questioned about Giuliani's statements by The New York Times. "From a public health standpoint, that has to be one of the more ridiculous things for any public official to have said over the past 30 years."
On Tuesday, Dr. Des Jarlais told The Week Online, "If these programs were cut off, you are probably looking at an 80% rate of relapse into heroin addiction. Of the population in methadone treatment, it's likely that 40% are HIV positive and at least 90% are positive for Hepatitis C. So sending them back out on the street would be a public health nightmare. The good news is that there is strong support for methadone maintenance, even among Republicans. And earlier this year, a National Institutes of Health consensus conference strongly recommended methadone, even high-dose methadone as a treatment for heroin addiction. When the science is that definitive, it is difficult for politics to overrule."
Des Jarlais noted that the Mayor of New York lacked the legal authority to shut down most of the programs, which are financed primarily with state and federal dollars. "It's clear that the mayor spoke mainly out of ignorance. When all of this gets hashed out, and the facts and the science are publicly discussed, I think that his error will become clear. Even to him."
(See our interview with Dr. Robert Newman, one of the leading authorities on methadone maintenance, item 9, below.)