Pubdate: Wed, 23 Aug 2000
Source: Bangor Daily News (ME)
Copyright: 2000, Bangor Daily News Inc.
Author: Barry McCaffrey
Note: Barry McCaffrey is the director of the Office of National Drug
Control Policy.


As the world production of heroin skyrockets, this drug has become cheaper and purer -- making it more accessible to people who smoke or snort heroin in addition to users who inject it intravenously. Sadly, the age of initiation is dropping for heroin so youngsters in Maine are increasingly at risk.

Drug Enforcement Administration agents in New England report that during the last three years, heroin trafficking rose 30 percent in their area of responsibility. Heroin is entering Maine from Massachusetts and New York. Communities in Maine’s Penobscot and Hancock counties are experiencing increasing rates of addiction. Heroin-related emergency-room episodes and deaths are becoming more prevalent.

In response to this situation, effective methadone treatment is currently available in Portland and Winslow. Fortunately, Acadia Hospital in Bangor is seeking a permit for a clinic in the northern part of the state to offer heroin addicts therapeutic services, including methadone. Gov. Angus King and Lynn Duby, commissioner of the state Department of Mental Health, Mental Retardation and Substance Abuse Services, both support this pharmacotherapy. Unfortunately, some public officials oppose methadone because they mistakenly believe it entails high failure rates and resembles giving wine rather than whiskey to alcoholics. Nothing could be farther from the truth.

Methadone therapy is one of the longest-established, most thoroughly evaluated and proven forms of drug treatment. A National Institute on Drug Abuse Treatment Outcome Study found that methadone reduced heroin use by 70 percent and criminal activity by 57 percent while increasing full-time employment 24 percent.

A 1998 review by the General Accounting Office states: “Re-search provides strong evidence to support methadone maintenance as the most effective treatment for heroin addiction.” Nationally, methadone helps keep 179,000 addicts off heroin, off welfare and on the tax rolls as law-abiding citizens.

A National Academy of Sciences study determined that “methadone treatment helps heroin addicts free themselves from drug dependency, a life of crime in support of their habit, and the risk of adding to the AIDS population by sharing dirty needles.” Some misguided critics have objected to methadone because they consider it simply the substitution of one addictive drug for another. However, as Dr. Avram Goldstein -- a nationally renowned scientist at Stanford University -- explains in his book, “Addiction, From Biology to Drug Policy,” not only does methadone provide an oral route of administration in place of syringes, but it also has “no adverse effects on cognitive or psychomotor function, performance of skilled tasks, or memory.”

Unlike heroin, methadone doesn’t make patients “high.” Dr. Goldstein notes that when heroin addicts are maintained on methadone, general health improves and hormones tend to normalize.

Goldstein likens use of methadone for recovering heroin addicts to insulin for diabetics. People suffering from severe cases of diabetes must take medicine daily because their bodies have lost the ability to produce substances needed to function properly. Once heroin addiction has changed the neurochemistry of the brain, the body no longer is able to synthesize certain chemicals in the absence of opiates.

Hopefully, the day will soon come when we will be able to cure people of the neurochemical consequences of drug habits. In the meantime, methadone treatment is the best option available for many heroin addicts.

Medical drugs are not inherently evil. Antibiotics, insulin, antidepressants and chemotherapy are among the many medications that have saved or improved millions of lives in the 20th century. The nature of a drug, not the frequency with which it is administered, is what distinguishes miraculous medicines from dangerous toxins. Abstinence-based drug treatment for heroin cannot always restore the neurochemical condition that preceded addiction. Simply stated, sometimes we can’t put Humpty Dumpty back together again the way he was before the fall.

The Office of National Drug Control is committed to expanding the availability of all forms of treatment, including methadone therapy and drug-free communities, to reduce the suffering caused by addiction. We are devoting substantial resources to accomplish this goal.

The White House asked Congress to provide $3.8 billion for drug treatment in fiscal year 2001, a 34 percent increase since 1996. Clearly, the entire nation would be better off with less drug dependence. Drug use is a choice -- and a bad one, at that. Heroin addiction, however, is a brain disease that frequently responds to a combination of drug-treatment measures which may include physician-supervised use of methadone, LAAM and naltrexone.

Maine’s medical community needs the authority to use methadone appropriately as one tool in a comprehensive drug-treatment package. If we don’t offer methadone programs, heroin addicts will remain on the streets.
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MAP posted-by: Terry Liittschwager