Use of methadone to slow AIDS spread hits red-tape barrier
Acquired immune deficiency syndrome (AIDS) has prompted new interest in the use of the synthetic narcotic methadone to help stop the spread of the AIDS virus by addicts who use hypodermic needles to inject drugs, principally heroin. Such drug abusers are the second-highest risk group for contracting AIDS. They are believed to be the primary source of transmission of the virus to newborns and the heterosexual, nonaddicted population.
Getting more drug abusers into methadone programs is seen as a way of combating addiction and the spread of AIDS simultaneously. But medical practitioners involved in providing methadone treatment say public policymakers are wrong to emphasize its use in preventing crime and unemployment as opposed to stressing its importance in stopping the spread of AIDS. Because it is administered orally, methadone eliminates the possibility of spreading AIDS through needle sharing.
Methadone is a legally prescribed narcotic substitute for heroin. Dr. Edward Senay, a veteran in the study of methadone treatment, at the University of Chicago Department of Psychiatry, says the health status of addicts in methadone treatment improves significantly and their crime rate diminishes eightfold.
The Methadone Maintenance Treatment Program of Beth Israel Medical Center in New York City is the largest in the world. It treats 7,600 addicts a year. Nina Peyser, administrator of the program, claims that 95 percent of the center's methadone clients no longer inject heroin, 50 percent have jobs, and 13 percent are attending school. Ms. Peyser says that a federal regulation requiring that those taking methadone receive social-service counseling at a ratio of one counselor to 50 addicts has created a long waiting list for treatment.
But Charles Faris of Spectrum House Inc., the oldest drug rehabilitation program in Massachusetts, says: ``You can't just be dosing people without counseling. The counseling is the treatment. Methadone just puts people in a holding pattern. The intent is to become abstinent.''
Daniel Hillstrom, a consumer safety officer with the United States Food and Drug Administration, says the agency is doing everything in its power to help localities open centers to dispense methadone - including streamlining of the process for opening and maintaining distribution centers.
Irene (not her real name) says three years in methadone treatment saved her from heroin addiction. She says that, unlike temporary detoxification programs, maintenance on methadone offers an opportunity for people to change. She also says that a waiting list of six months or a year could be fatal - that ``a lot of people don't make it, and six months down the road they may not care anymore'' - particularly if they contract AIDS.
Now drug free, Irene says that methadone offers many addicts the possibility of gaining control of their lives.
Joe (not his real name) is one such person. He is now being forced off a methadone maintenance program because the local program he is in has a two-year limit. During this time Joe has stayed off heroin and found a job as a pet groomer. ``I want to stop [taking methadone],'' he says, ``but ... I don't think I'm ready yet. I don't know what's going to happen.''
In an article for the New England Journal of Medicine, Dr. Robert Newman, who directs the Beth Israel Medical Center in New York, says methadone treatment is medical care and that decisions on policy that affect people like Joe should be the responsibility of the medical community.
Barry Brown at the addiction research center of the National Institute on Drug Abuse (NIDA) disagrees. He says methadone has always been thought to be ``an adjunct to treatment rather than a treatment itself.''
Mr. Brown says two NIDA studies conducted from 1969 to 1981 showed that 44 percent of those surveyed had successfully left methadone and become drug free.
Dr. Senay, in an article in the British Journal of Addiction, estimated the cost of methadone maintenance for one patient in the United States at $2,200 a year. The cost for the methadone alone he put at $50 to $100 a year.
Methadone is substituting one problem for another, says Dan Langdon, vice-president of Phoenix House, operators of rehabilitation centers in New York and California.
He says ``use is use is use'' and methadone won't change causes for behavior. He touts a 75 percent success rate with a program of counseling and in-patient therapy without the use of drugs in treatment.
``Methadone is not the answer, being drug free is the answer,'' says Irene. ``But the bottom line is that if methadone saves one person's life, then it's worth it.''