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Profile: Methadone Maintenance
The "Invisible" Success Story

Client and couselor

A client receives counseling along with her medication at Beth Israel's methadone clinic.


Every day some 115,000 Americans take the prescribed drug methadone, a synthetic opiate, used as maintenance treatment for heroin addiction. Studies find that two-thirds of methadone patients show dramatically decreased drug use, decreased criminal involvement, and improved life circumstances.

Heroin is one of the hardest addictive drugs to "kick" for good. It provides a euphoric rush, and chronic users can experience intense cravings for more of the drug even years after last use.

Methadone can help with these problems. It is also an opiate, but because it is taken orally, it does not provide a euphoric rush. It is long-acting, so the patient no longer experiences the extreme ups and downs that accompanied the waxing and waning of heroin blood levels. Furthermore, because methadone actually blocks the "high" from any heroin use, a patient on it has little motivation to use heroin again. Essentially, the patient remains physically dependent on an opiate, but is freed from the compulsive, uncontrolled, and disruptive use seen in heroin addiction.

Still, misconceptions abound and continue to limit methadone's availability. Neighborhood groups often oppose a new clinic because they assume it will lead to higher rates of drug use and crime (studies show these rates actually go down). And those favoring a "drug-free" approach often dismiss methadone maintenance as merely "substituting one drug for another."


The Beth Israel Program

Despite such skepticism, Beth Israel Medical Center in New York has prescribed methadone for 33 years, serving some 8,000 patients in 22 clinics throughout the city. Patients receive not only their prescribed methadone, but a comprehensive range of medical care, drug and health education, and counseling.

Those enrolled at Beth Israel's program are racially diverse and include lawyers, bankers, homemakers, graduate students, and musicians, as well as some long-term unemployed. Peter Vanderkloot, 33, a patient and now a counselor in the program, notes that, despite this diversity, a stereotype of methadone patients persists because most successful methadone patients are "invisible." "The better someone does in treatment, the more successful he or she becomes in life, the more secretive he or she is about being on methadone," says Vanderkloot. "We're simply not who people think we are."

Methadone by Prescription

Methadone treatment has long been hampered by government regulations that require most patients to come to the clinic five to seven days a week. This requirement works against patients' efforts to maintain employment, as they must often leave work and travel some distance to keep appointments.

Recently, U.S. drug "czar" Barry McCaffrey recommended making methadone more readily available by allowing doctors to prescribe it like any other medication (as is already done in Great Britain, the Netherlands, Germany, Australia, and elsewhere).

Beth Israel has been experimenting with this approach for some time. A special "medical maintenance" program allows long-standing patients to take home a four-week supply of methadone to self-administer. Edwin A. Salsitz, M.D., director of the program, likens the prescribing of methadone for addicts to prescribing insulin for diabetics. In either case, he says, "It's simply a medical treatment for a medical condition."

For further information about admission, call: (212) 420-2389.

For other program information, contact Marie Marciano, Administrator, at: (212) 387-3930.

-- Donna Boundy


This description is not intended as an endorsement of this particular program.

This article is an excerpt from the Viewer's Guide for MOYERS ON ADDICTION: CLOSE TO HOME, produced by Thirteen/WNET's Educational Publishing Department. The entire guide is available, free of charge, by downloading it to your computer or requesting a copy by mail.

Photo: Courtesy of Beth Israel Medical Center

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