August 19, 1998
Giuliani's Methadone Proposal Is Backed by Little Evidence
Join a Discussion on Mayor Giuliani and New York City Politics
By DAVID M. HALBFINGER
EW YORK -- It took Diana, a 34-year-old recovering heroin addict from the Bronx, exactly 95 days to wean herself from methadone at a residential clinic on Manhattan's Lower East Side last year.
"I counted every day," she says. "On Dec. 8, they announced I was drug- free. It was the greatest feeling in my life."
Diana's success in getting off methadone in a little more than three months would seem to support Mayor Rudolph Giuliani's call to move 2,000 heroin addicts off methadone at city hospitals -- an initiative grounded in a belief that most addicts would need only about 90 days to achieve total abstinence.
But Diana, who spoke on the condition that her last name be withheld, is hardly typical of methadone users. She is a college graduate with a long work history and a supportive family. And her heroin use had lasted only six months, compared with a decade or more for most recovering addicts taking methadone. Even so, it has taken her more than a year of intensive counseling, training and therapy to feel ready to return to the outside world.
Experience at the few methadone-to-abstinence programs in New York shows that they produce lasting results in only a small number of methadone users and that success comes much more slowly than city officials might like to believe. Critics say that without any research to back it, the administration's plan amounts to a risky experiment in drug treatment on a vulnerable population.
"It's not for everybody," said Ruben Medina, chief executive of Promesa, a Bronx multiservice agency that offers methadone-to-abstinence treatment along with open-ended methadone programs. "Some clients are very strong and prepared to move off methadone quickly," he said. "With others, who are marginalized in virtually every definition of the word, you have to, in effect, rebuild a whole human being."
The city's policy shift, which could take effect in as little as two months, has drawn vehement criticism from drug treatment experts in government and medicine who say it defies decades of scientific research showing that methadone maintenance offers the best hope for the vast majority of recovering heroin addicts. Of those who stop using methadone, they say, more than four out of five relapse within months, often with deleterious physical, psychological and social effects.
The mayor has characterized open-ended methadone treatment as an exchange of one chemical dependency for another, and he has said that the city would be doing addicts a disservice if it did not urge them to free themselves of both heroin and methadone.
The Giuliani administration's plan is based on the city's experience with a methadone-to-abstinence program at Kings County Hospital in Brooklyn that treats about 50 patients a year, Dr. Luis Marcos, president of the Health and Hospitals Corp., said.
The program, which lasts 6 to 12 months, is offered alongside a larger methadone maintenance program that treats 700 people a year at the same hospital and would be closed under the new plan.
Under the city's plan, said Marcos, those weaned from methadone in an average of 90 days would receive counseling afterward, including referrals to so-called drug-free communities and other rehabilitation programs.
A spokeswoman for Marcos was unable to provide data on the rate of relapse among patients. "We haven't done any scientific studies, with controlled experiments and so forth," the spokeswoman, Jane Zimmerman, said. "We're a public hospital system. We don't do that."
But Dr. Stephen Zukin, director of clinical and services research at the National Institute on Drug Abuse, part of the National Institutes of Health, said he knew of no rigorous studies of such methadone-to-abstinence programs. He cautioned that such research ought be done in small numbers, not "by mayoral decree" affecting hundreds or thousands of patients.
Dr. Vincent Dole, a retired professor at Rockefeller University who in the early 1960s first promulgated methadone maintenance as a treatment for heroin addiction, called the Giuliani administration's plan "a radical experiment with no research or background and certainly not with the informed consent of any of the subjects."
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