METHADONE: Drug Czar To Propose Expanded Treatment Plan

      White House Drug Czar Barry McCaffrey today is expected to announce new government policy "to expand the availability of methadone to all those who need it," the New York Times reports. After consultation with substance abuse specialists and government agency officials, McCaffrey is expected to "recommend that for the first time, doctors be allowed to administer methadone to patients in the privacy of their offices." The new program, expected to go into effect this December, will expand access to methadone, transfer its regulation from the Food and Drug Administration to the Substance Abuse and Mental Health Services Administration, and create an accreditation system to analyze the quality of clinics' methadone treatment programs. The expansion policy modifies current procedures making methadone available only at special clinics, often at times that conflict with recovering addicts' job schedules. It also aims to provide methadone to a substantially increased number of the country's 810,000 opiate addicts -- only 115,000 addicts currently undergo methadone treatment.

State Resistance?
      The Times notes, however, that states have control over methadone programs, which could thwart the federal government's expansion efforts. Several states -- New Hampshire, Vermont, West Virginia, Mississippi, North Dakota, South Dakota, Montana and Idaho -- prohibit methadone clinics, forcing recovering addicts to travel across state lines. Backers of the new program hope the government's "stronger endorsement of methadone's efficacy" will encourage states to establish or expand methadone programs. New York City Mayor Rudolph Giuliani's (R) main criticism is that methadone programs "simply exchang[e] one addiction for another," and are "tantamount to enslavement." However, McCaffrey, "in an implicit reference to the Mayor's criticism ... cautioned against engaging in 'shoot-from-the-lip policy analysis.'"

Pushing Change
      Proponents of the policy change cite a recent National Academy of Sciences study that found methadone to be the most effective therapy currently available for opiate addiction. Mark Kleiman of the University of California-Los Angeles noted that the new federal policy "sound[ed] very much like the recommendations made by the panel of specialists" from the study. "Everybody in the field agreed that the panel got it right," he said, adding, "If what the panel said is going to be policy, I can only say, 'Hurray'" (Wren, 9/29).

Rangel Weighs In
      An op-ed written by U.S. Rep. Charles Rangel (D-NY) in today's New York Daily News asserts that Mayor Giuliani's "scattershot criticism of methadone treatment [is] irresponsible and off the mark." He applauds McCaffrey's goal of "bring[ing] real order to the delivery of methadone services." Rangel concludes that the "new effort holds much promise. It should be the position of all responsible public officials in our city to support it" (9/29).