Woman Injured In One-car Crash

Adversity Makes Arena All The More Remarkable    

Sunday, November 14, 1999 &nbsp;&nbsp;&nbsp;&nbsp;Page: 6B 





As much as we believe that a local methadone clinic is essential to
addressing our region's heroin problem, we cannot refrain from asking: &nbsp;&nbsp;&nbsp; 
 Are the proponents of a ``methadone-to-abstinence'' clinic fooling
themselves or trying to fool the public? &nbsp;&nbsp;&nbsp; Whatever the answer, we believe those who concentrate on abstinence are
ill-advised. But we welcome any initiative aimed at stemming the rising local
death toll from heroin. &nbsp;&nbsp;&nbsp; 
 Local law-enforcement, government and treatment officials who joined forces
to thwart an Allentown agency that wanted to locate a clinic here now say they
are working toward the establishment of a methadone-to-abstinence program
affiliated with a local treatment center. Unlike traditional
methadone-maintenance programs in which addicts may take daily doses of
methadone for years, patients in an abstinence program would be given
methadone for four to six months. &nbsp;&nbsp;&nbsp; 
 Those officials are not only making medical judgments for which they are
unqualified, they are advocating a mode of treatment that has little support
from experts in the field. &nbsp;&nbsp;&nbsp; 
 ``Not a single article in the extensive world-wide literature concerning
methadone treatment supports such a practice,'' Dr. Robert Newman, president
of Beth Israel Medical Center in New York City, has written of methadone
treatments with rigid time limits. &nbsp;&nbsp;&nbsp; 
 In study upon study, the most knowledgeable experts in the field of opiate
abuse have concluded that programs attempting to wean patients from methadone
in six months fail to even approach the success methadone-maintenance programs
have achieved in keeping addicts heroin-free. &nbsp;&nbsp;&nbsp; 
 After examining such abstinence programs, a 1994 working group for the New
York State Office of Alcoholism and Substance Abuse Services concluded: ``In
most studies about 80 percent of the former patients relapse to use of heroin
and/or other narcotics within approximately two years after leaving treatment
... Programs which encourage patients to withdraw from methadone are not
setting policies based on scientific evidence, nor are they serving their
community.'' &nbsp;&nbsp;&nbsp; 
 ``The more effective programs ... prescribed higher doses of methadone and
had maintenance rather than abstinence as their treatment goal,'' according to
a 1992 Australian study. &nbsp;&nbsp;&nbsp; 
 ``The experience of the past several decades demonstrates conclusively that
drug-free treatment is simply not enough - not nearly enough!'' Dr. Newman of
Beth Israel wrote in 1992. ``Stubbornly clinging to the paradigm of abstinence
as the only acceptable therapeutic orientation ... condemns the vast majority
of heroin addicts to continued suffering and, all too often, to death.'' &nbsp;&nbsp;&nbsp; 
 Why have District Attorney Peter Paul Olszewski Jr., Wyoming Valley Alcohol
and Drug Services Inc. CEO Carmen Ambrosino and other members of the Luzerne
County Heroin Task Force instrumental in blocking a methadone-maintenance
clinic latched on to ``abstinence''? Because it allows them to escape a trap
of their own making. &nbsp;&nbsp;&nbsp; 
 Citing unfounded concerns about increased crime around clinics - concerns
unsupported by any scientific study, survey or statistical analysis - local
officials scuttled plans for a methadone-maintenance clinic and then watched
the number of heroin-related deaths mushroom, unabated by mandatory drug
sentences or education programs. Having rejected the one, admittedly
imperfect, treatment proven to help transform heroin addicts into useful
members of society, local officials had nowhere to turn. &nbsp;&nbsp;&nbsp; 
 By insisting on ``abstinence,'' they can save face while opening the door
to methadone, which experts agree is the most effective treatment for reducing
heroin-related crime and keeping addicts heroin-free. Does methadone
maintenance substitute one drug for another, as its opponents claim? Not
really. Methadone blocks the effects of heroin, the craving for the drug and
withdrawal symptoms, but produces no ``high.'' Methadone patients are able to
function responsibly, hold jobs and contribute to society. The opprobrium
heaped on methadone by its opponents is largely undeserved. Many researchers
liken methadone maintenance to insulin treatment for diabetics. &nbsp;&nbsp;&nbsp; 
 A well-regulated methadone-maintenance program - in which patients may take
the drug only in a clinical setting - can save lives, reduce crime and restore
families without endangering the community at large or encouraging street
sales of black-market methadone. &nbsp;&nbsp;&nbsp; 
 And make no mistake. Northeastern Pennsylvania needs a methadone clinic -
about two dozen of our neighbors travel daily to the New Directions clinic in
Allentown for methadone-maintenance treatment and another 30 are on a waiting
list to begin such treatment, according to clinic officials. Luzerne County
budgets about $16,000 annually to pay New Directions for treating county
residentsMD112. &nbsp;&nbsp;&nbsp; 
 Someday there may be treatment options that will allow most addicts to kick
heroin without long-term reliance on daily methadone treatment. But that day
is not yet here. &nbsp;&nbsp;&nbsp; 
 Perhaps some of them can succeed in a methadone-to-abstinence program. But
studies show the majority probably won't. Therefore, we should be making more
than one type of treatment and more than one type of methadone treatment
available to them. &nbsp;&nbsp;&nbsp; 
 We believe a local methadone-to-abstinence clinic - once it is established
and once medical decisions best made by patients and doctors are removed from
the political arena - will branch out, by necessity, into methadone
maintenance. &nbsp;&nbsp;&nbsp; 
 Those who insist on abstinence can deny that with all their might. If that
denial is the price of bringing methadone to Northeastern Pennsylvania, we,
along with all the heroin addicts who sorely want treatment, can live with
that. &nbsp;&nbsp;&nbsp;

Addicts, Abstinence And The Politics Of Methadone