Sunday, August 20, 2006

Methadone Survives 4 Decades of Tough Politics (API August 12, 2006)

Methadone Survives Four Decades of Tough Politics
Associated Press Writer
Newsday, August 12, 2006

NEW YORK -- In the late 1960s, a band of black militants paid a visit to a Brooklyn medical 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 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 last week 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 treatment of heroin addiction, Beth Israel Medical Center, marked the 40th anniversary of its methadone program, the first to apply the treatment he 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 1 in 6 of all methadone patients in the city.

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

"That's been the frustration of my life for the past 35 years," said Dr. Robert Newman, president emeritus of Continuum Health Partners and 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 is still assailed by critics who say it keeps patients in a drug-dependent limbo. Clinics face resistance wherever they open. Public figures from Howard Dean to 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 first 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, who had taken to commandeering unused office space in Harlem to offer treatment to addicts.

"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 usually make addiction so crippling.

Once their dose is calibrated, people taking methadone don't experience withdrawal symptoms or physical cravings for more narcotics. The drug blocks them from experiencing the euphoric rush from injecting heroin.

It is also cheap and long-lasting. Patients down a dose in the morning and feel normal for the rest of the day _ no different than someone taking pills for high cholesterol.

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

A downside of methadone is that it only works for as long as someone takes it, meaning that most clinics recommend that patients use it daily and indefinitely.

That might not be a burden, patients say, if getting methadone was as easy as filling a prescription.

It is not.

"This is a magnificent medicine," Torres said. "The problem is what you have to do to get it."

At the Vincent P. Dole clinic in Brooklyn, patients begin lining up at 7 a.m., some having traveled for an hour to reach the office. The clinic, tucked behind an unmarked entrance in a busy shopping plaza, is pleasant enough. What makes it grueling, patients say, is the routine.

A majority of people in the program must come every weekday for their dose _ even if they have jobs, or come down with the flu, or get hit by a blizzard. Medical vans carry in elderly or disabled patients too frail to commute.

Aside from doses given out for the weekends, take-home supplies of methadone are a tightly regulated privilege.

Many patients only qualify for two or three weeks of take-home doses following years of clean urine samples, which in some cases are collected in the presence of a staff member to eliminate tampering.

"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, and researchers have said it could hold some advantages over methadone.

Among other things, buprenorphine lasts longer, is more difficult to overdose on, and can be given in a doctor's office _ a potentially huge advantage over the clinic system.

Newman said it is too soon to tell, but he hopes both drugs will 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.

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