This became glaringly apparent on January 13 and 14, when international physicians, researchers, policy makers, drug users, and social workers gathered at Seattle's Sheraton Hotel for the Heroin Overdose Conference. Germany, Holland, and even Australia are focusing on addiction as a public health problem rather than a criminal issue, and thus are blazing trails -- dramatically cutting back overdose deaths, crime, and dollars spent on medical traumas. We might do well to follow the lead of these countries who accept maintenance -- versus abstinence -- as an acceptable goal for some drug users.
You wouldn't know it from reading the mainstream media coverage of this month's conference, but a recent local development, taking place below the radar screen, is in sync with the radical European approach. Dr. Joe Merrill of Harborview Medical Center is launching a pilot methadone program for stabilized patients.
What's edgy about Merrill's project -- slated to begin February 1, 2000 and funded by the Robert Woods Johnson Foundation -- is how it normalizes and de-stigmatizes methadone maintenance. Instead of patients picking up their methadone and being monitored in social-service-based drug treatment facilities, they will go to a physician's office at Harborview. Participants in the pilot project will have their lives and time freed up. Instead of standing in line at a social service agency once a week for seven daily doses of oral methadone, participants will eventually be able to pick up a whole month's worth of medication during a scheduled physician's office visit.
"This project is an enormous step. Methadone is the most tightly controlled drug in the world," says Eric Detzer, who has been in a methadone maintenance treatment program for the past 33 months. "It will be much easier and much cheaper to go to a doctor's office. After a certain point, you don't need urine tests and extra services like counseling. Methadone costs me $200 a month, and insurance doesn't pay for it."
Methadone is an effective legal substitute for people dependent on opiates, most commonly heroin. It has neither the withdrawal nor the euphoric side effects of heroin, thus people who use methadone as prescribed can function well. Methadone is an important drug treatment option in Seattle, where we have an estimated population of 10,000 active addicts, as well as a high heroin overdose death rate, which has doubled since 1990 to 144 deaths in 1998.
To put his experiment into play, Merrill was granted state and city waivers to be able to stretch dosage dispensing to one month. (A week's worth of methadone is the current legal limit.) If Merrill's program succeeds and serves as a model, methadone users might eventually live as free of social stigma as people on anti-depressants.
"Methadone maintenance is not that different from injecting insulin every day or having high blood pressure," Merrill says.
But methadone treatment is still limited in Seattle and throughout Washington. At this point, methadone licenses have to be approved by county councils throughout the state, with a cap of 350 clients who can be served on each license. Only four Washington counties -- Yakima, Spokane, King, and Pierce -- have licensed dispensing facilities.
That situation may soon improve. Senator Julia Patterson (D-Normandy Park) has introduced a bill (SB-5019) for the second session in a row, which would lift the cap of 350 per license, allow for the oversight of programs through the Department of Health rather than county councils, and allow a limited number of physicians to dispense methadone.
Patterson says she has encountered little resistance to methadone treatment, even among conservative members of the state legislature. However, she is critical of the lack of investment in drug treatment here.
"The state of Washington should be ashamed of itself," Patterson says.
She has a point. We can look to countries that are less fearful of drug maintenance programs for guidance and inspiration. For example, Germany and Holland have had success with Safe Injection Rooms -- managed facilities where heroin addicts shoot up, surrounded by health workers and resource people. Other countries are also further along in offering public health solutions to addiction, such as distributing heroin overdose prevention information to users, as well as dispensing Narcan, an antidote for heroin overdoses.
Ron Jackson, Seattle harm reduction expert and Executive Director of Evergreen Treatment Services, claims that solutions like Safe Injection Rooms and Narcan (which has not been thoroughly researched) are not on the near horizon in Washington.
Jackson applauds people like Patterson and Merrill, who are laying the groundwork for a philosophical shift in the way we think about drug treatment.
