Taylor West, [email protected]
San Francisco took another step this week in efforts to greatly expand access to methadone treatment for heroin addicts. Acting on a resolution passed by the San Francisco Board of Supervisors in February 1998, a working group of physicians, pharmacists, and methadone patients advised the city to make methadone treatment more easily available by allowing more doctors to prescribe the drug to addicted patients. Federal and local funds have been allocated to study the feasibility of such a move.
Methadone is a synthetic narcotic that curbs heroin cravings without causing the extreme highs and lows associated with heroin use. It has proven successful in helping addicts stabilize their lives and end their heroin addictions without suffering from severe withdrawal. In San Francisco, as in most of the country, methadone treatment is carried out primarily through clinics, where patients must go daily to receive their prescribed dose.
However, the San Francisco working group concluded that by using only large scale methadone providers like clinics, many heroin users are not getting the treatment they need. The group's suggestions centered around adapting the methadone treatment system to include more individual doctors prescribing methadone and the cooperation of some pharmacies in supplying the dosages.
Dr. Alice Gleghorn, Research Manager for the Community Substance Abuse Services division of the San Francisco Department of Health, explained the concept to the Week Online. "We're trying to expand treatment availability across the board," he said. "We're not talking about every doctor in the city now being allowed to prescribe methadone. We want to create a larger program for certifying physicians, with training and education, and involve certain pharmacies as well." Gleghorn explained that many individual doctors' offices do not have the facilities to fill the daily distribution needs of methadone patients. However, by allowing certified doctors to prescribe methadone and involving pharmacies in the distribution process, the system can be made more personalized and accessible to the city's heroin users.
Support for expansion of methadone treatment has been notably strong in San Francisco. "We are the one city in the country with a completely unified response to the methadone system," Gleghorn said. "Every [local government] department has been very supportive. We know how bad our heroin problem is. Thirty years of research has demonstrated that methadone is one of the most effective treatments for heroin addiction."
In the federal government, regulation of methadone programs is in the process of changing over from the jurisdiction of the Food and Drug Administration to that of the Center for Substance Abuse Treatment. Because the effects of this changeover are uncertain, it is not clear how federal law will relate to San Francisco's plans. However, both President Clinton and Drug Czar Barry McCaffrey have expressed support for methadone treatment programs and a dissatisfaction with the current methadone system.
Dr. Gleghorn emphasized the integrated nature of the city's plans for its methadone program. "This is simply one part of San Francisco's efforts to provide treatment-on-demand to our drug addicts. No other city is making that as much of a priority as we are. This is another effort to improve access to treatment, the choices, and the care available to those addicted to drugs. That is our overall strategic goal."
Read our coverage of the federal government's proposed changes to methadone regulations at http://www.drcnet.org/wol/101.html#methadoneregs.