TURNAROUND RUDY PUTS $5M
IN METHADONE CLINICS
By
SUSAN RUBINOWITZ
New York Post
October 6, 1999
Mayor Giuliani has backed off further from his vow to end methadone treatment for
heroin addicts – funding a $5 million expansion of the city’s clinics. The money
is going to methadone centers at all 11 public hospitals to extend clinic hours
and add job-training and psychological evaluations, said city Health and
Hospitals Corporation spokeswoman Jane Zimmerman.
The move comes a year after Giuliani called Clinton administration drug czar
Barry McCaffrey “a disaster” for backing methadone treatment over abstinence.
Under fierce attack, Giuliani softened his stance, allowing that a few methadone
clinics might need to stay open. Zimmerman said the aim of Giuliani’s latest
move is “making the goal abstinence rather than maintenance, but accomplishing it
through a series of incremental steps that focus on vocational counseling, job
placement and rehabilitation.”
Sources told The Post that even before the mayor’s campaign for addicts to go
cold turkey, city health experts were pushing to expand social services for them.
The extra funds will allow clinics to stay open evenings, in order to serve
working patients.
“What a lot of people do when they’re wrong about something is they take a swing
and backpedal at the same time,” said Bob Weiner, a spokesman for McCaffrey. “We
are delighted that the mayor understands the importance of the program from both
the treatment profession and law enforcement’s point of view.”
Other targets of Giuliani’s barbs for their methadone stands applauded him for
changing his mind – whatever the motivation. “It’s been a wonderful turnaround,
and the mayor clearly listened to a number of his advisers,” said Mark Parrino,
president of the American Methadone Treatment Association, a city-based group
that represents 675 methadone programs nationwide.
Dr. Edwin Salsitz, who runs a methadone program at Beth Israel Medical Center,
said that after backing off and talking to experts, Giuliani “realized that what
he said wasn’t completely correct.” Salsitz’s clients, all employed, get their
methadone supplies at a doctor’s office once a month. “I give the mayor credit
for becoming more knowledgeable and helping rather than harming,” Salsitz said.
Read about the history of Mayor Guiliani’s remarks.
Methadone Maintenance
Not What it’s Cracked Up To Be
Letters
New York Post
October 11, 1999
letters @nypost.com
* I’m not sure why everyone is so happy that the mayor terminated his vow to end
methadone (“Turnaround Rudy puts $5M in Methadone Clinics,” Oct 6).
They must be the same administrators, consultants, physicians and politicians
who spent 30 years being complacent about the treatment of this illness.
As for the may, I would like to congratulate him in implementing workfare during
his tenure.
With workfare, chemically addicted individuals are given the opportunity to earn
money legally and to eventually seek vocational and educational services.
Methadone maintenance was implemented four decades ago for rehabilitation
purposes, and only now are we beginning to discuss it. Something must be dread-
fully wrong.
Raymond Sanchez
Gramercy Park Medical Group
Methadone Program
Manhattan (via e-mail)
* Mayor Guiliani’s pouring $5 million into methadone treatment – in order to
eventually get patients to stop taking the medication – is arrogant and ignorant.
Whoever advised Guiliani that getting a job cures substance dependence, a
neurobiological, largely genetic and chronic disorder, should start running for
cover now. The workfare initiative will fail.
Seventy-five percent of heroin addicts and methadone-maintenance patients
already have jobs. What does this tell us about the relationship of vocational
rehabilitation to the need for methadone maintenance? The majority of
methadone patients supported by public funds who are not working suffer
medical and psychiatric disabilities and have no real prospect for gainful
employment, not to mention functioning with methadone.
What the mayor should have done with $5 million is admit another 1,000
patients to methadone treatment.
What is laudable is that some methadone patients will get increased access
to vocational rehabilitation, and that others whose employment was endangered
or prevented by limited hours of access to methadone will benefit.
Marc Shinderman, MD
Center for Addictive Problems
Chicago, ILL (via e-mail)
* The Health and Hospitals Corporation has repeatedly stated that methadone
maintenance does not address the underlying causes of addiction, and perpetuates
indulgence.
The purpose of treatment should be abstinence and self sufficiency, including
work, not maintenance on an addictive drug.
We disagree strongly with the Office of National Drug Control Policy and General
Barry McCaffrey, who encourage a culture of dependency rather than promoting
freedom from addiction and employment.
Substituting one addictive drug for another is not a solution to the problem of
substance abuse.
Helping addicted men and women be free of methadone and obtain employment
as quickly as possible are solutions that offer a chance to lead health and productive
lives.
The goal of the HHC’s five methadone programs continues to be abstinence,
rehabilitation and employment in the shortest possible time. The $5 million
referred to in your piece is not being used to provide addiction methadone but,
in fact, to help people more quickly achieve abstinence and get jobs.
Luis R. Marcos, M.D.
NYC Health and Hospitals Corp.
Manhattan
The first letter by Mr. Sanchez is a wonderful example of sticking ones foot in ones mouth or shooting yourself in the foot. HE IS THE DIRECTOR OF A METHADONE PROGRAM! No wonder the field is limping around so. But to understand why this fellow has been limping around one had to understand the system in New York. For the public who reads this they will think that even methadone programs think methadone patients are lazy and won’t work. This is far from the truth. It is the providers who do not want patients to work because they get more money for Medicaid patients. Through the years providers have reduced vocational services for patients to a point where they do not exist in many programs. Over the years the end result is that only 29% of methadone patients are working in New York. Now this figure is somewhat deflated because off the books work is no longer counted as employment as it once was but it still does not account for the great reduction. Compare this to figures up to about 1980 when 75% of patients were working or going to school. This is an impressive figure for a group that have criminal histories and are highly stigmatized, face discrimination and had no legal protection. Yet they worked and improved their social standing primarily because they were encouraged to and the programs were very different in those times because most staff actually believed in patients. It is amazing what patients can do when they are given their dignity back!
Therefore, Mr. Sanchez needs to direct his criticism at himself and his fellow providers who have created a system that demeans and infantilizes patients and takes the easy way. Mr. Sanchez should investigate why the early programs whose only purpose was to illiminate criminal behavior were able to do so much more.
As for Dr. Luis Marcos — shame on him as the public health advisor to the Mayor. It is a tradegy to see anyone lose their ethics and it is particularily tragic when it harms so many others.
NAMA agrees with Dr. Shinderman. Jobs will not treat addiction or at least no more than employment would treat cancer or heart disease. The chronically unemployed in NYCs programs are patients with serious social, mental health and medical conditions. Most are unemployable and need other services which they will probably not get. The vocational services may help the new admissions to program who tend to be younger.