Scott Ehlers, Drug Policy Foundation, ehlers@dpf.org
Senator John McCain (R-AZ) introduced S. 423, the "Addiction Free Treatment Act," on February 11, which would significantly reduce the number of methadone patients and the amount of time patients would be allowed to be maintained on methadone. According to Sen. McCain, methadone maintenance is "Orwellian," and "disgusting and immoral," and must be stopped to restore the humanity of the enslaved addict.
The bill would require: (1) Medicaid payments for methadone and Levo-Alpha Acetyl-Methadol (LAAM) treatment to be terminated after a maximum of six months; (2) clinics to conduct random and frequent comprehensive drug testing; and (3) the termination of a patient's treatment if he/she tested positive for illicit drugs. Federal funds administered by the Substance Abuse and Mental Health Services Administration would also be subject to the same restrictions.
In addition to these new federal restrictions, S. 423 would require the National Institute on Drug Abuse to conduct a study within three years to determine: (1) the methods and effectiveness of non-pharmacological, as well as methadone-to-abstinence rehabilitation programs. The Center for Substance Abuse Treatment would be required to submit annual reports for five years on the effectiveness of non-pharmacological and methadone-to-abstinence treatment.
Sen. McCain's bill is very similar to a plan promoted last year by New York City Mayor Rudolph Giuliani, which would have required methadone patients at city hospitals to be abstinent within 90 days. At the end of five months, only 21 of the 2100 patients were methadone-free, and five of those had relapsed into heroin use. In January of this year the mayor abandoned his plan, saying it was "maybe somewhat unrealistic."
Doctors, patients, and patient advocates have derided the McCain bill, and are surprised that he would introduce it after Giuliani's proposal failed so miserably. Dr. Marc Shinderman, medical director of the Center for Addictive Problems in Chicago, mused: "It appears that Giuliani's perfected technique of identifying a stigmatized group and attacking it has become contagious to Republicans outside of New York. McCain is either painfully ignorant of the facts regarding the value of methadone maintenance treatment or is politically motivated to attack it in spite of the overwhelming evidence of its efficacy."
He added, "The Institute of Medicine's 1998 Consensus Report on Heroin Addiction called methadone maintenance the 'gold standard' in the treatment of heroin dependence. The abstinence-based treatment advocated by McCain was found to result in relapse rates of 90 percent."
Patient advocates are equally upset by the bill. Beth Francisco of the Advocates for Recovery Through Medicine, found the bill to be "horrible," and believed it would result in less people entering methadone treatment, more people relapsing into heroin use, and more diversion of methadone into the black market for persons kicked out of programs. Joycelyn Woods of the National Alliance of Methadone Advocates noted that "the wording of McCain's bill is demeaning and he is obviously operating from a position of bias and misunderstanding. I'm surprised that a senator would be this ignorant about this issue."
S. 423 had no co-sponsors at press time and was referred to the Senate Finance Committee.
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