In a speech before the American Methadone Treatment Association in New York on Tuesday (9/29), US Drug Czar Barry McCaffrey announced a plan to restructure federal guidelines on methadone in order to make the treatment more available to those who need it. While methadone has been exhaustively studied and is widely hailed as the single most effective treatment for opiate addiction, it is currently available to only 115,000 of the estimated 800,000+ heroin addicts nationwide.
"Methadone treatment is simply not available for Americans in all parts of the country in a manner called for by rational drug policy," McCaffrey said. He stated that the Office of National Drug Control Policy (ONDCP) which he heads has set a goal of "adequate methadone treatment capacity for all of America's opiate drug addicts."
One of the major stumbling blocks to methadone treatment, aside from its scarcity, are the severe restrictions placed on its administration. Currently, only special clinics may distribute it. Clinics often have short hours and many patients must travel great distances each day to receive their dose, which is supervised by clinic staff. Dosages administered by clinics are also often sub-optimal, leaving addicted patients still struggling with the constant cravings and withdrawal symptoms that methadone is intended to ward off.
McCaffrey said that he would like to see private doctors licensed to prescribe the drug, and standards set for effective dosages, counseling and care.
While this is not the first time McCaffrey has publicly called for an easing on restrictions surrounding methadone treatment (see http://www.drcnet.org/wol/014.html#mm), the speech took on added significance due to a war of words taking place between the Administration and Republican Mayor Rudolph Giuliani of New York, who has vowed to phase out methadone treatment in the city (see http://www.drcnet.org/wol/051.html#giuliani).
Dr. David Lewis, professor of medicine at Brown University and project leader for Physician Leadership on National Drug Policy, told The Week Online, "Barry McCaffrey's views on treatment and on methadone in particular have been known for some time. And while I think that he'll have difficulty in making the bureaucracy move as quickly as he would like, in the long run, I don't see why we won't have methadone distribution from physicians' offices as they do in most countries in Europe. It's relatively trouble-free and physicians can be easily trained to do this. He's on the right track, and he's got science on his side and the medical establishment as well in terms of the National Academy of Science and the consensus review panel of the American Medical Association."
Giuliani, reacting to reporters' questions regarding McCaffrey's statements, said "This is what the Clinton Administration and General McCaffrey are advocating: more people dependent on a chemical."
Studies have consistently shown that up to 90% of people who are forced off of methadone will relapse into heroin addiction. Earlier this week, a full-page ad was run in the New York Times, signed by scores of medical and treatment professionals touting the effectiveness of methadone over any other known treatment for opiate addiction, as well as the fact that methadone allows people to live normal, productive lives.
In response to Mayor Giuliani's high-profile war on methadone, Dr. Lewis said, "It really makes me sad, more than angry. Looking back on anti-methadone history in this country, mostly during the early part of the twentieth century, it's surprising that a modern-day politician could take such a stance. It makes one think that there are other factors at work here, besides a concern over rational policies or science and medicine. I think that as this debate plays out in the public, it will become apparent to people that on the issue of methadone, Mayor Giuliani's position is misguided."
(For some interesting background material on this issue, see http://www.drcnet.org/wol/020.html#methadone, as well as our recent interview with Dr. Robert Newman, one of the nation's pre-eminent experts on methadone and addiction at http://www.drcnet.org/wol/051.html#newman. The National Alliance of Methadone Advocates can be found online at http://www.methadone.org.