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Methadone For Adicts Still Under Fire

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"The number of fatal overdoses from the drug has nearly quadrupled as more and more doctors prescribe methadone in pill form as an alternative to drugs like OxyContin."

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Methadone for Adicts Still Under Fire

Tuesday, August 15, 2006

NEW YORK - In the late 1960s, a group of black militants paid a visit to a Brooklyn clinic to discuss the new treatment it was offering heroin addicts, a drug called methadone. They came armed with bayonets.

"They were going to kill me," recalled Dr. Beny Primm, director of the Addiction Research and Treatment Corp. "They thought I was part of the white man's way of enslaving black folk, and one of the ways they enslaved black folk was to put them on methadone."

Methadone's long struggle for acceptance has been a topic of discussion again lately with the death Aug. 1 of Dr. Vincent Dole, a founding father of its use as a treatment for addiction.

His passing came eight weeks after another force in the field of heroin addiction, Beth Israel Medical Center, marked the 40th anniversary of its methadone program, the first to apply the treatment Dole and Dr. Marie Nyswander developed at Rockefeller University.

The mood of both events was largely celebratory. Study after study has validated Dole's methods, and Beth Israel's methadone program now serves 6,000 patients at 17 clinics, or about one in six of all methadone patients in the city.

And yet, supporters of the medication also voiced a regret: Even after four decades, methadone is mistrusted by the public, just as it was in the days when militants were banging on Primm's door.

"That's been the frustration of my life for the past 35 years," said Dr. Robert Newman, a longtime overseer of the methadone program at Beth Israel. "There are no votes to be garnered by supporting methadone. The knee-jerk reaction of most voters when they hear someone wants to shut clinics down is applause."

Today, the medication - a liquid narcotic that eases heroin cravings without getting patients high - is still assailed by critics who say it keeps patients in a drug-dependent limbo. Clinics face resistance wherever they open. Public figures such as Howard Dean and Tom Cruise have assailed methadone programs as morally flawed.

As recently as 1998, Rudolph Giuliani, then mayor of New York, announced a plan to do away with methadone treatment in all city-run clinics. The goal of every addict, he said, should be total abstinence.

The plan never got off the ground, but it illustrated how little the debate about methadone has changed since Dole and Nyswander began promoting the medication in 1964.

Drugs like heroin were then viewed predominantly as a criminal problem rather than a medical one. Addicts were shunned, even at hospitals, which rarely had beds for detoxification.

The suggestion that heroin users be switched to methadone, an equally addictive narcotic, struck some as illogical. One of the early skeptics was Primm.

"I didn't understand it," he said. "We're going to legally give narcotics to people? That was kind of antithetical to what we'd been taught."

Over time, though, methadone won him over because of its ability to alleviate the symptoms that make addiction so crippling. Once their dose is calibrated, people taking methadone do not experience withdrawal symptoms or physical cravings for more narcotics. The drug blocks the euphoric rush addicts get from injecting heroin.

Patients drink a dose in the morning and feel normal for the rest of the day.

"It's very boring. There is no high to it," said Lisa Torres, a lawyer who has taken methadone for 16 years, including her time at law school.

In recent years, controversy has found methadone again - this time over its use as a painkiller. The number of fatal overdoses from the drug has nearly quadrupled as more and more doctors prescribe methadone in pill form as an alternative to drugs like OxyContin. In 2003, methadone was listed as a cause of 2,452 unintentional poisoning deaths in the U.S., up from 623 in 1999, according to the National Center for Health Statistics.

A downside of methadone when used to fight heroin addiction is that it works only as long as someone takes it, meaning that most patients have to take it every day for the rest of their lives. And that is a burden, patients say, because getting methadone is nowhere near as easy as filling a prescription.

At the Vincent P. Dole clinic in Brooklyn, patients begin lining up at 7 a.m., some having traveled for an hour. Most people in the program must come every weekday for their dose - even if they have jobs, or they come down with the flu, or the city gets hit by a blizzard.

Extra doses are given out for the weekends, but larger take-home supplies of methadone are tightly regulated. Many patients qualify for two or three weeks of take-home doses only after years of clean urine samples.

"It's so burdensome. It's so onerous. It's so unbelievably awful," Torres said of the clinic system. "There has to be a better way."

Just what the future holds for the treatment is unclear.

In the past few years, a promising alternative called buprenorphine became available on a limited basis. Buprenorphine lasts longer, is more difficult to overdose on and can be given in a doctor's office.

Newman said he hopes both drugs eventually overcome the stigma that still surrounds drug treatment.

"I pin my hopes on the fact that people will realize that it has to be better if there are 50,000 or 200,000 fewer people using heroin on the street, shooting up, getting AIDS," he said.

Source: http://home.peoplepc.com/psp/newsstory.asp...0815-1734322069

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