Ease Restrictions on Methadone, Says NIH Panel

TREATMENT January 1998

Heroin addiction is a medical disorder that can be effectively treated if doctors are freed from restrictions on the use of methadone, according to 12-member independent expert panel at a National Institutes of Health (NIH) conference on heroin ("Program and Abstracts: NIH Consensus Development Conference on Effective Medical Treatment of Heroin Addiction, Office of the Director, National Institutes of Health, November 17-19, 1997; "Paul Recer, "Federal Panel Backs Fewer Restrictions On Prescribing," Orange County Register, November 20, 1997, p. 15; Associated Press, "Methadone rules rapped," Houston Chronicle, November 20, 1997, p. 26A, "Heroin Addicts Treatable, Doctors Say," San Francisco Examiner, November 20, 1997, p. A9).

The panel chairman, Lewis L. Judd, M.D., of the University of California, San Diego, said physicians are reluctant to treat heroin addiction because of cumbersome paperwork and "onerous" regulations imposed on the use of methadone. Currently, methadone is regulated by the Food and Drug Administration, the Drug Enforcement Administration, the Department of Health and Human Services (DHHS), and numerous state laws. "We know of no other area of medicine where the federal government intrudes so deeply and coercively into the practice of medicine," Judd said. "If extra levels of regulation were eliminated, many more physicians and pharmacies could prescribe and dispense methadone" he said. Judd estimated that there are 600,000 heroin addicts in the U.S., and only about 115,000 are enrolled in methadone maintenance treatment (MMT) programs.

The panel found, "Of the various treatments available, MMT, combined with attention to medical, psychiatric, and socioeconomic issues, has the highest probability of being effective." The use of other methods of heroin treatment, such as levo-alpha acetylmethadol (LAMM) and buprenorphine, "is at an early stage, and it may be some time before their usefulness has been adequately evaluated." "DHHS can more effectively, less coercively, and much more inexpensively discharge its statutory obligation to provide treatment guidance to MMTs, physicians, and staff by means of publications, seminars, Web sites, continuing medical education, and the like" ("NIH-Sponsored Independent Consensus Panel Calls for Increased Availability of Methadone Treatment with Less Government Regulation," CESAR FAX, December 1, 1997, Vol. 6, Issue 47.)

Methadone, a synthetic narcotic used to treat heroin addiction, has some of the same physiological effects on the brain as heroin and helps blunt the effects of heroin withdrawal. Because methadone does not produce a "high," and it takes several hours for its biological effects to occur, Judd said methadone is not attractive to drug abusers. "Laws to control methadone diversion are no longer necessary," Judd said. He said the laws were passed to limit distribution of methadone because of apprehension it could be sold on the black market to heroin addicts.

Eric Sterling, president of the Criminal Justice Policy Foundation, in brief remarks to the panel urged them to recommend MMT for use in American prisons. "Heroin use and needle sharing is rampant in American prisons, and AIDS is rapidly spreading. Now is the time to start discussion of MMT in prison to slow the spread of HIV."

Held on November 17-19, 1997 the panel's conclusions support an earlier Clinton Administration proposal made in September by Gen. Barry McCaffrey, National Drug Control Policy Director, for more physician control of methadone. "We have a failed social policy and we have to correct it," McCaffrey said (Christopher S. Wren, "U.S. Convenes Experts on Drugs To Grapple With Heroin Use," New York Times, September 30, 1997, p. A25).

Despite the belief that heroin addiction is a moral or legal problem, the experts said research clearly shows that heroin addiction is a medical disorder linked to genetic predisposition and social conditions.

To obtain a copy of the NIH consensus statement, call (888) NIH-CONSENSUS or visit the NIH Consensus Development Program Web site at http://consensus.nih.gov.