Well, do you think you know a little more now than before? We hope so. It's been over 35 years since the earliest effective studies on the use of methadone in treating heroin addicts. There had been some utilization in the Federal Penitentiary System, but it wasn't until the work of Dole and Nyswander in New York, that the social effects of methadone began to come to the forefront. The history is worth reading for perspective.

The Goal: Harm Reduction
Methadone is sometimes considered the Grandfather of Harm Reduction. Although it is difficult for many who have been involved in drug abuse prevention and treatment to accept, there are some people for whom abstinence from all drugs is not the solution. These include many folks who have experienced some problems with alcohol or other drugs but don't have a pattern that could be termed addiction, to be sure. But also included are some people who ARE addicted - they just can't seem to live comfortably without a dose of chemicals in them. Faced with these circumstances, proponents of harm reduction propose that, rather than abandoning these people as "treatment resistant", we look for ways to minimize the damage they do to themselves and others. Even if there is a long term goal of abstinence, the short term goal of minimizing the damage can be legitimate. Methadone programs proved themselves effective from the very start. The complex relationships between the law, the economy of illicit drug sales, and the inherent effects of heroin on the human body kept addicts in a vicious cycle of crime, poverty, and drug-affected health. The heroin addict seeking relief for the discomfort of withdrawal found it only in more heroin, which was expensive (partly because it was illegal). The use of heroin led to semi-conscious or unconsciousness, making it difficult to maintain a job or career. Money for mor drugs couldn't be raised by legitimate means, so illegitimate means were all that were left. Many heroin addicts were (and are) prostitutes, thieves, or dealers of drugs themselves.

Methadone is not heroin. The ability to take methadone, which is provided cheap or free, and which - while staving off the discomfort of withdrawal - does not produce either great euphoria or the somatizing aftereffects of heroin, allows addicts to live normal, functional lives. What has been found of alcoholics and other addicts is true for heroin addicts as well, absent the mind-crunching effects of the drug, they are a cross-section of the society, with at least as many productive, creative, and valuable people represented as in any population sample. This is real harm reduction.

Another area in which methadone maintenance has had a harm-reduction impact involves AIDS and HIV. One of the more common ways these deadly illnesses are spread is through needle sharing, a not-uncommon practice of heroin addicts. Methadone is generally administered in an oral, liquid dosage, and is given under strict conditions. The practice thus has a primary preventive effect on the spread of blood-borne disease. A huge network of methadone maintenance programs has developed across America and in other countries as well. Systems have been developed where people can get dosages daily or even weekly. Some methadone maintenance clients are trusted with taking their doses home or on trips with them. It is even possible to have a job in which you travel frequently, and your needs are met in various cities.

Trouble in Paradise?
Obviously, methadone maintenance has not proven to be the magic solution to heroin addiction in the United States. It is not the perfect, or only solution. The number of heroin addicts continues to increase and the number of people needing methadone maintenance goes up as well. It is costly to continue to maintain people on methadone. One of the primary arguments for abstinence-based treatment is that it stops costing society money once the treated person achieves and maintains abstinence. While this argument has validity, advocates of methadone maintenance take pains to try to insure that things aren't taken to extremes. The current concern over SB 423 provides a good example of how things can get confused.

Then, too, there are abuses associated with the delivery system. Methadone is a drug of abuse, and although highly regulated, there are many cases of diversion and illegal sale of methadone. Within the array of service providers, it is not uncommon to hear of abuses of power, in which "administrative detox", or the withholding of methadone dosages, occurs for reasons ranging from lack of participation in counseling, to use of other drugs while in the program, to failure to pay your monthly fee on time. There seems to be no clear cut guidelines for operating programs that everyone agrees upon. As is true with all issues in the area of addiction, there is more to be done, before we are done!

Conference Announcements

Drug Abuse and AIDS: Intertwined Epidemics
July 15, 1999: Satellite Symposium: "Drug Abuse and AIDS: IntertwinedEpidemics", Westin Ottawa, Ottawa, Ontario, Canada, sponsored by theNational Institute on Drug Abuse (NIDA), National Institutes of Health(NIH), will characterize unique problems associated with drug abuse andHIV/AIDS, and discuss NIH research grant opportunities. Contact: Kathleen Janson, (301) 468-6008, x432.

Conference on Ibogaine The Conference on Ibogaine will be held on November 5 and 6, 1999 at the New York University School of Medicine. Participants in the Conference will represent the basic and clinical neurosciences, the disciplines of ethnography and sociology, and the FDA, NIDA and the pharmaceutical industry. The promotion of discussion and exchange of information and views among the participants receives significant emphasis in the Conference program and agenda. Topics to be covered include ibogaine's mechanism of action, safety and efficacy, interaction with memory and neurophysiology, and ethnographic and policy perspectives. For more information visit the conference Website at http://www.med.nyu.edu/Psych/ibogaineconf/

Substance-Abusing Adolescents with Co-Occurring Disorders
May 3-4, 1999
Palmer House Hilton, Chicago.
Peg Rider-Hankins, Development Director
Mayor's Office of Substance Abuse Policy
DePaul Center, Room 320
333 South State Street
Chicago, IL 60604
312-747-2614

New Links

Medical Marijuana in the Capitol article from Mother Jones.
AA Deprogramming Website - Perfect for those who need AA deprogramming! Huh?
The Agency for Healthcare Policy and research presents Pharmacotherapy for Alcohol Dependence.
The Off-Center Writers Block Mall - Stories of addiction and pain, transcendence and redemption. Don't miss this one!

The Role of Cognitive Errors in the Drug Policy Debate. It's about as dry as it sounds, but wade on through!

AFG new address:Al-anon Family Groups, Inc.
1600 Corporate Parkway
Virginia Beach, VA 23454-5617

A new email and snail mail address was sent to us from Drogadictos Anonimos, a Spanish-speaking group out of New York dedicated to sobriety and recovery. You can get in touch with them at Drogadictos Anonimos
746 9th. Avenue. Lower Level
New York, NY, 10019
Tel: (212) 445-0401
e-mail: .