Pubdate: Thu, 13 Apr 2000
Source: Bangor Daily News (ME)
Copyright: 2000, Bangor Daily News Inc.
Contact:  http://www.bangornews.com/
Author: Jay McCloskey is the U.S. attorney for Maine.

METHADONE TREATMENT OF LAST RESORT

Low-cost, high-purity heroin has come to northern Maine. Within the past 18 
months, the law enforcement community has seen a dramatic increase in 
heroin use in Penobscot and Hancock counties. Abuse of prescription drugs, 
such as Oxycodone-Oxycontin, which are used for a "heroin-like high," has 
also dramatically increased.

Since October 1998, there have been four heroin-related deaths in Bangor. 
In Penobscot County there was a 176 percent increase in admissions 
reporting heroin as a substance used-abused from 1998 to 1999. The Bangor 
Police Department has reported a significant increase in the number of 
thefts and burglaries committed by heroin users seeking money to sustain 
their habits. Kids - high school-aged and younger - are known to be using 
heroin in the Greater Bangor area.

In November 1999, the law enforcement community within Penobscot and 
Hancock counties, particularly troubled by the speed with which heroin had 
taken hold, developed and began implementing a comprehensive plan to drive 
heroin out of northern Maine.

In February of this year, just as the heroin initiative was getting under 
way, the Bangor Daily News reported that the Maine Office of Substance 
Abuse (OSA) and Acadia Hospital planned to open a methadone clinic in 
Bangor. Neither OSA nor Acadia had bothered to consult with the city of 
Bangor or the law enforcement community about the advisability of a 
methadone clinic.

Dr. Thornton Merriam from Acadia Hospital estimated that "within a year as 
many as 200 addicts may be seeking meth-adone treatment at the clinic." 
Acadia planned to locate its methadone clinic near a child care center in 
the city of Bangor's business park. They intended to be fully operational 
by March of this year. Acadia also indicated its desire to open additional 
clinics in Somerset and Washington counties in the near future.

Methadone maintenance as a treatment for narcotic addiction has been 
controversial since its inception in the early 1970s, and it remains 
controversial today. Methadone is a Schedule II narcotic that provides 
effects similar to morphine and heroin. One former methadone user 
de-scribed methadone treatment as the medical equivalent of "giving an 
alcoholic wine to keep them from drinking whiskey."

In addition to very high failure rates (one study concluded that up to 47 
percent of its patients continued to use heroin), methadone maintenance 
programs create other problems for law enforcement. Methadone diversion, 
which includes the sale by patients of take-home doses and theft of 
methadone from clinics, is a serious problem. One study reported "13 
percent of narcotics users not in treatment were methadone addicts whose 
primary drug of abuse was methadone." Annually, a significant number of 
methadone-related overdose deaths are reported.

Most experts agree that methadone, to the extent it has any validity as a 
treatment, is a last-resort option for people who have not been able to 
kick their narcotics addiction by any other treatment method. According to 
Joanne Ogden, of the OSA, once individuals begin methadone treatment they 
can expect to keep on taking methadone until they die.

Both New Hampshire and Vermont prohibit long-term methadone maintenance and 
encourage alternative treatments. Gov. Howard Dean of Vermont, who is also 
a physician, responded to an attempt to introduce long-term methadone 
maintenance in Vermont: "I don't have enough bad things to say about it." 
Dr. Robert Dana, senior associate dean of students at the University of 
Maine and former chief research consultant to the state of Maine for issues 
of risk and protection regarding drug use, who once ran a methadone 
treatment program in Tennessee, has opposed the proposed methadone clinic 
in Bangor.

The issue is not whether methadone is ever an appropriate treatment in 
places like New York City where there are thousands upon thousands of 
long-term addicts. The issue is whether it is appropriate at this stage of 
Bangor's heroin problem, when it is, by all accounts, a treatment of last 
resort.

There is a better way to address northern Maine's new but rapidly growing 
heroin problem. It will require coordinated participation from several 
segments of our community. In addition to an aggressive interdiction 
strategy, a public awareness campaign and an educational program must 
begin. The Maine Office of Substance Abuse's mission includes education, 
prevention and demand-reduction as well as treatment, yet we have heard 
nothing about their efforts in these areas. It is my hope that OSA will 
assist northern Maine in implementing a coordinated prevention and 
demand-reduction program.

I am not ready to concede defeat to a permanent opiate population in Bangor 
and surrounding communities that will only grow over time. But the 
development of a community-based heroin reduction program is going to take 
more than a few months. I call upon both OSA and Acadia to agree to a 
moratorium on methadone clinics in northern Maine for at least two years, 
to give our community a chance to eliminate the availability of and the 
demand for heroin.
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MAP posted-by: Jo-D