Source: Times Union (NY) Contact: http://www.timesunion.com/ Fax: 518-454-5628 Pubdate: Sat, 03 Oct 1998 DRUGS, SCIENCE AND SENSE The nation's drug czar offers a sound plan for treating heroin addicts. Add the reasoned voice of Barry McCaffrey to the all-too-often strident debate over how to treat heroin addiction. Mr. McCaffrey, a former Army general who now serves as the White House drug policy czar, has come forth with a sound plan to make methadone more available to heroin addicts. He wants to allow some doctors to be able to prescribe methadone, which prevails on brain receptors to block the craving for heroin, directly to their patients. He also wants to improve the quality of the clinics that now dispense methadone to about 115,000 addicts nationwide, including 42,000 in New York. What's most refreshing about Mr. McCaffrey's initiative is that it regards methadone as medicine and drug addiction as a medical disorder, not unlike heart disease, hypertension or diabetes. Methadone, by his reasoning, should be as available as insulin and heart and blood pressure medication. On that point in particular, Mr. McCaffrey is supported by a vast group of doctors and addiction specialists alike. Among them is David C. Mactas, president of the Hazelden drug treatment programs in the New York City area. "That methadone is effective is not a matter of opinion,'' Mr. Mactas says. "It is a matter of fact.'' The opposition comes, predictably, from political quarters. New York City Mayor Rudolph Giuliani in particular has become a vicious critic of methadone treatment. The mayor moralizes that the country should be drug free and notes that it is possible to become physically dependent on methadone, too. He goes so far as to suggest that such a dependency is even worse than heroin addiction -- an assertion unsettling to the point of being breathtaking. It's one thing for Mr. Giuliani to lean on taxi drivers and hot-dog vendors. But it would be best if he'd stay out of a public health discussion that he shows little evidence of understanding. The data offered by Mr. McCaffrey is compelling. When methadone is properly administered to addicts, he says, their heroin use declines by 70 percent. The crimes they commit drop by 57 percent. Gainful employment among addicts, meanwhile, increases by 24 percent. How can Mr.Giuliani responsibly object to any of that? Others, however, may raise responsible objections to Mr. McCaffrey's plan on the grounds that it doesn't provide enough funding to ensure success. Mr. McCaffrey promises only that federal spending on drug treatment will increase by 38 percent during the next five years. Methadone programs, though, will need money immediately. No less an authority than Dr. Jerome Jaffe, who was an early proponent of methadone treatment during his days as drug policy director for the Nixon administration, points out what should be obvious: Most people who need such help can't afford to pay for it. We've had reason to criticize Mr. McCaffrey before. Earlier this year, he refused to pay for needle-distribution programs, despite convincing evidence that clean needles save addicts' lives. Proper funding for the expanded methadone treatment effort he's proposing, though, would allow him to claim the high road in the drug policy debate. - --- Checked-by: Rich O'Grady