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"Drug Czar" McCaffrey Proposes Expansion of Methadone Programs for Heroin Addicts

TREATMENT

September-October 1998

On September 29, General Barry McCaffrey, director of the Office of National Drug Control Policy (ONDCP), announced a proposal to make methadone more readily available as a treatment for heroin addiction (Gary Fields and Mark Truby, "Drug chief wants to expand availability of methadone," USA Today, September 30, 1998, p. 5A; Beth J. Harpaz, "White House drug chief endorses expansion of methadone program," Wisconsin State Journal (Madison), September 30, 1998, p. 5A; "Drug Czar Wants To Make Methadone More Available," Virginian-Pilot (Norfolk), September 30, 1998, p. A7).

McCaffrey, speaking at the American Methadone Treatment Association conference in New York City, said that methadone availability could be expanded, in part, by allowing physicians to dispense the synthetic heroin substitute in their offices.  Current regulations only permit methadone to be dispensed at special clinics, which makes it difficult for addicts to receive their daily dose while holding down jobs and raising families. "Methadone treatment is simply not available for Americans in all parts of the country in a manner called for by rational drug policy. We've got to do better," McCaffrey said. He said ONDCP has set a goal of "adequate methadone treatment capacity for all of America's opiate drug addicts." An accreditation process for methadone clinics would be established and standards for dosages, counseling, and care would be set.

By early 1999, the Clinton Administration plans to redraft the federal regulations which govern methadone. Officials
indicated that Congressional approval would most likely not be necessary for the changes. Policy makers hope that this strong endorsement of methadone's efficacy by the federal government will spur state interest in this treatment. States have wide control over the availability of methadone. Eight states -- Idaho, Mississippi, Montana, New Hampshire, North Dakota, South Dakota, West Virginia, and Vermont -- do not allow methadone clinics, forcing resident addicts to travel to other states for treatment (Christopher S. Wren, "Federal Proposal Would Provide Methadone to More Drug Addicts," New York Times, September 29, 1998, p. A1).

McCaffrey also promoted the easing of restrictions on methadone use and improving the quality of methadone clinics. Dr. Edwin A. Salsitz, who has overseen a pilot prescription program for the U.S. Food and Drug Administration (FDA), said giving physicians the ability to prescribe methadone would bring more middle- and upper-class users into treatment. Such users tend to avoid treatment due to the stigma associated with lining up daily for treatment at a clinic. Robert Newman, M.D., president of Beth Israel Medical Center in New York City, which runs the world's largest methadone maintenance program, said, "The message is, let's get the treatment of narcotics addiction back into the purview of general medicine. . .I am disappointed it didn't happen sooner, because every passing month that we deny potentially lifesaving medicine to people who need it is a travesty" (Christopher S. Wren, "A Proposal to Expand Methadone Is Welcomed," New York Times, September 30, 1998, p. A19).

The "drug czar" said that responsibility for regulating methadone would pass from the FDA to the Substance Abuse and Mental Health Services Administration in the year 2000. While not providing any cost figures for the new policy, he indicated that federal financing for drug treatment would increase by 38% during the next five years. Jerome Jaffe, M.D., former drug policy director in the Nixon Administration, who pushed methadone treatment, warned that setting tougher accreditation standards without providing sufficient funding could put some struggling programs in poorer communities out of business. Jaffe, who is now a clinical professor of psychiatry at the University of Maryland School of Medicine in Baltimore, said, "The problem is the prejudices and biases against this treatment, and the fact that most people can't afford to pay for treatment out of their pockets."

Many of these proposals have been advocated for many years. A drug policy advisory committee to Baltimore Mayor Kurt Schmoke made many of these recommendations in 1993. The Mayor's Working Group on Drug Policy Reform included David Altschuler, Ph.D.; Peter Beilenson, M.D., M.P.H.; Judge Robert Bell; L. Tracy Brown, Esq., Robert Embry, Jr.; Ripley Forbes; Howard Levine, Esq.; Clarence Lusane, J.D., Ph.D.; Wallace Mandell, Ph.D.; Patrick Murphy; Ethan Nadelmann, J.D., Ph.D., Sidney Schnoll, M.D., Ph.D.; Ronald Shapiro, Esq.; Soloman Snyder, M.D.; Eric E. Sterling, Esq.; Linda Thompson, Ph.D.; Arnold Trebach, J.D., Ph.D.; and Kevin Zeese, Esq. ("Report of the Mayor's Working Group on Drug Policy Reform," November 1993, p. 16).

In an editorial, the Chicago Tribune wrote: McCaffrey's announcement that the federal government "intends to facilitate the use of methadone to treat heroin addiction is a significant step toward a more realistic--and effective--anti-narcotics policy, with a greater focus on treatment of those afflicted" (Editorial, "Bring methadone out into the open," Chicago Tribune, October 9, 1998, sec. 1, p. 28).

Gen. Barry McCaffrey, Office of National Drug Control Policy - 750 17th St., NW, 8th Floor, Washington, DC 20006,
Tel: (202) 395-6618, Web: <http://www.whitehousedrugpolicy.gov>.

Robert Newman, MD - Continuum Health Partners, Inc., 555 W. 57th St., New York, NY 10019, Tel: (212) 523-8390,
Fax: (212) 523-8433, E-mail: <rnewman@bethisraelny.org>.

Jerome Jaffe, MD - 701 Pratt St., University of Maryland, Department of Psychiatry, Room 334, Baltimore, MD
21201, Tel: (410) 328-1815, Fax: (410) 328-1749.