Methadone Harder to Obtain Than Heroin, Addicts Report

TREATMENT February 1997

Recovering heroin addicts are reporting that their efforts to get methadone, a medication used to treat opiate addiction, are hindered by the federal government's ban against prescribing the drug, by state prohibitions, and by a shortage of treatment slots. It is more difficult for recovering addicts to obtain methadone than the heroin that they are trying to resist (Christopher S. Wren, "Ex-Addicts Find Methadone More Elusive Than Heroin," New York Times, February 2, 1997, p. A12).

Methadone, a synthetic narcotic that does not produce a high at therapeutic dosage levels, is a Schedule II drug (considered to have a high potential for abuse but with an accepted medical use). Patients usually take it daily for long periods of time for successful treatment. The country's most tightly controlled legal drug, methadone is only available at specially licensed clinics, which are "run by a bureaucracy" and "difficult to access," according to Dr. Henry Blansfield, a retired surgeon who has treated substance abuse for 20 years. In addition to a narcotics license, clinics are required to have as many as three methadone licenses -- one each at the federal, state, and county level, according to Joycelyn Wood, executive vice president of the National Alliance of Methadone Advocates (NAMA), in an interview with NewsBriefs.

Eight states -- Idaho, Mississippi, Montana, North Dakota, South Dakota, West Virginia, Vermont and New Hampshire -- do not allow methadone clinics. Because of this, it is not uncommon for patients in those states to drive several hours round trip every day to receive their methadone treatment out of state. Omere Luneau, a New Hampshire carpenter, drives four hours every day to Massachusetts for his treatment, at a cost of about $625 a month, including gas. Often, recovering heroin addicts, who hold jobs and are responsible parents, suffer from withdrawal if they miss their methadone dose due to common frustrations such as bad weather, family emergencies and traffic congestion.

Methadone is almost never dispensed by prescription. Alice Randolph-Diorio of Vermont, who has undergone 26 surgeries related to problems with her pelvis and spine, is one of the exceptions. She is a recovering heroin addict who used to drive three hours to get methadone until a doctor convinced health officials to allow her to have a prescription. Wood told NewsBriefs that Randolph-Diorio's doctor circumvents the federal ban by prescribing methadone for her pain, not for her addiction recovery. "It's frightening to think that the only way for a person to get methadone here is to suffer from chronic pain," said Randolph-Diorio.

Other exceptions exist. Woods told NewsBriefs that the FDA has already exempted about a dozen patients who live long distances from clinics, but that patients must find a doctor willing to fill out the extensive paperwork. Dr. Edwin Salsitz runs a methadone clinic in New York City at Beth Israel Hospital that operates as a "special research project." About 1,000 long-term, stable patients receive prescribed methadone under Salsitz's care, according to Wood.

"A methadone patient is monitored more closely than a paroled murderer," said Salsitz. This monitoring exists because methadone "can cause very serious damage to public health and public safety" and is "causing so many deaths and arrests," claims Terence Woodworth, deputy director of the DEA's Office of Diversion Control. However, a 1995 study by the Institute of Medicine, a branch of the National Academy of Sciences, found tht methadone caused only "minimal medical harm." Furthermore, the study said, "The number of cases in which methadone has been documented as the sole direct cause of death is very small." (Richard A. Rettig and Adam Yarmolinsky (eds.), "Federal Regulation of Methadone Treatment," Washington, D.C.: National Academy Press, 1995.)

Woodworth said stringent controls were mandated by Congress in 1974 to prevent diversion of the drug. The DEA argues that letting addicts take methadone home might lead addicts to sell it in order to buy street drugs. Methadone patients admit that some diversion exists, though usually to other addicts who cannot get into treatment programs. There are an estimated 600,000 heroin addicts in the United States, and only 115,000 treatment slots. "If I wanted to get high, I'd buy heroin," said Wood. She said only addicts looking to stabilize their lives would buy illegal methadone. David Lewis, M.D., the director of Brown University's Center for Alcohol and Addiction Studies, confirmed Wood's contention that methadone is not a popular street drug.

Woods told NewsBriefs that federal regulations are currently being rewritten to allow reliable patients to leave clinics and seek methadone maintenance under a physician's care. Woodworth said the DEA would endorse such a change because "it minimizes diversion." Woods added that four states  -- New Hampshire, Vermont, Connecticut and California -- have recently moved to allow for prescribed methadone. Still, a doctor's prescription is not easy to get because addicts are often stigmatized by doctors as "junkies," according to Wood. She recommends building a relationship with a doctor before asking about methadone maintenance. She said stigmatization of recovering addicts by society is still the greatest obstacle for those seeking methadone treatment.

National Alliance of Methadone Advocates, 435 Second Avenue, New York, NY 10010, Tel: (212) 595 NAMA (6262), E-mail: nama@interport.net or visit the NAMA website at http://www.methadone.org.

California Advocates for Methadone Patients (CAMP), P.O. Box 245606, Sacramento, CA 95824, Tel: (916) 456-4775.