In July, New York Mayor Rudolph Giuliani announced the end of methadone treatment programs in New York City within the next four years. The Mayor accused methadone treatment of substituting one addiction for another. He hopes to replace methadone programs with complete abstinence, a more "moral" means of treatment. Methadone, taken orally by recovering addicts to quell the desire for heroin, is used by about 40,000 persons in New York City (Rachel L. Swarns, "Mayor Wants To Abolish Use of Methadone," New York Times, July 21, 1998, p. B1; Beth Gardiner, "Giuliani Plans to Wean Methadone Users," Washington Post, August 23, 1998, p. A16).

Giuliani's announcement came days after the director of the Office of National Drug Control policy, Barry McCaffrey, said that his recent trip to Europe had convinced him of the effectiveness of methadone treatment in combatting heroin addiction. Upon learning of Giuliani's announcement, McCaffrey said, Giuliani's "recent statements about methadone therapy are at odds with the conclusions of the nation's scientific and medical community." New York Deputy Mayor Joseph Lhota responded, "Maybe the reason our nation's war against drugs has stalled is because our vaunted drug czar favors massive increases in chemical dependency" (Christopher Wren, "Drug Czar Assails Mayor For Opposing Methadone," New York Times, July 25, 1998, p. B3).

Mayor Giuliani's comments provoked a debate on the op-ed pages of the New York Times among physicians, treatment clinic officials, and concerned citizens. Sally Satel, M.D., a psychiatrist who works in a Washington methadone clinic, wrote that, while methadone treatment can be effective, poorly run programs can promote use of other drugs. Satel said many clinics tolerate use of drugs like cocaine, which undermines the patient's treatment and harms the clinic's credibility in the eyes of other patients (Sally L. Satel, "Methadone Works, Usually," New York Times, July 22, 1998, p. A19).

Marc Shinderman, M.D., the medical director of the Center for Addictive Problems in Chicago, called Satel's piece "ill-informed." Shinderman said, though some people on maintenance therapy do use cocaine and other illicit drugs, the methadone clinics do not encourage this. He pointed out that good clinics offer services such as psychiatric counseling and behavioral interventions which help to reduce drug use (Marc Shinderman, Letter to the Editor, New York Times, July 25, 1998, p. A12).

Mark Parrino, president of the American Methadone Treatment Association, said of Giuliani's plan, "The first thing that will happen is that 80 percent of these people will relapse. . .We know it. It's happened in other cities. . .From a public health perspective it's an absolute disaster" (Beth Gardiner, "Anti-Methadone Stand Arouses Critics," Daily Gazette (Schenectady, NY), August 22, 1998, p. B5).

A number of experts told the New York Times that because federal and state money pay overwhelmingly for the methadone programs in New York, Giuliani, as an officer of the city, is not empowered to shut most of them down (Ian Fisher, "Mayor's Drive Against Methadone Has Little Chance, Experts Say," New York Times, July 22, 1998, p. B1).

However, the city controls methadone treatment for 2,000 heroin addicts at city-run hospitals. Mayor Giuliani expressed his intention to replace indefinite methadone maintenance with a methadone-to-abstinence program at the five New York hospitals. His plan would allow addicts to remain on methadone for a few months before suspending access to the drug (David M. Halbfinger, "Little Evidence To Back mayor On Drug Plan," New York Times, August 19, 1998, p. A31; Rachel L. Swarns, "Giuliani Orders 5 City Hospitals To Wean Addicts Off Methadone," New York Times, August 15, 1998).

Gen. Barry McCaffrey added, "The problem isn't that there are too many methadone programs, it is that there are too few. . .Close down methadone programs and (addicts) will be back on the streets, back on drugs, and back on welfare."

Even some officials who offer abstinence programs feel that a variety of alternative treatments should be available. Ray Diaz, a senior vice president of Samaritan Village, a New York treatment center that includes a methadone-to-abstinence program, said, "This model doesn't work for everyone. We need a number of different treatment models at city hospitals. Methadone maintenance programs are vital" ("Mayor Steps Up His Criticism Of Methadone Programs," New York Times, August 16, 1998).

Mayor Rudolph Giuliani's Press Office - City Hall, Press Office, New York, NY 10007, Tel: (212) 788-2958, Fax: (212) 788-2975.

Gen. Barry McCaffrey, Office of National Drug Control Policy - 750 17th St., NW, 8th Floor, Washington, DC 20006, Tel: (202) 395-6618, Web: <http://www.whitehousedrugpolicy.gov>.

Sally Satel, M.D. - (202) 638-8911, Fax: (202) 638-1505.

Marc Shinderman, M.D., Center for Addictive Problems, 609 North Wells, Chicago, IL 60610, Tel: (312) 266-0404, Fax: (312) 266-8169.

American Methadone Treatment Association - 217 Broadway, Suite 304, New York, NY 10007, Tel: (212) 566-5555, Fax: (212) 349-2944, Web: <http://www.assnmethworks.org>.•