The Lesser Evil

Like thousands of other addicts, Dan Smith spent most of his life trying to support his heroin habit. Hooked at 17, he was subsequently convicted 18 times for drug possession and related offenses. Neither fear of jail nor intensive efforts by doctors freed him from drugs. But today Smith's life is significantly different. At 42, he is married, and he recently left his job as a shoe salesman to help rehabilitate other addicts. As far as heroin is concerned, he is clean. Still, Dan Smith (not his real name) is an addict of sorts. Every morning he stops at Manhattan's Beth Israel Medical Center to down a cup of Tang spiked with methadone, a synthetic drug that he takes to overcome his craving for heroin.

New Habit. For all its dramatic effects, methadone therapy still stirs strong argument within the medical profession. The debate began in 1964 when Drs. Vincent Dole and Marie Nyswander first started using the drug to wean addicts away from heroin. Methadone programs, which cost an average of $1,500 a year for each addict--as opposed to $5,000 to $10,000 for a year in prison --are operating in most major U.S. cities. About 10,000 of the country's estimated 200,000 heroin victims now participate in some form of methadone treatment; thousands more are waiting to enroll.

There is no question that methadone, particularly when combined with psychological counseling, offers the well-motivated addict a relatively easy way to give up heroin. Developed as a morphine substitute in Germany during World War II, methadone relieves pain and eases the symptoms of heroin withdrawal without producing euphoria or the craving for ever-increasing dosages. But methadone has one quality in common with the heroin it replaces: it is just as addictive. Most of those who use it must continue their new, though less destructive habit indefinitely. While less painful than heroin withdrawal, kicking methadone can take longer. For most patients, the result is hardly worth the effort. A long-term heroin habit so alters the body's chemical makeup that life without opiates is virtually impossible. Therefore most addicts who give up methadone quickly return to heroin. Methadone generally works well for mature addicts, some as old as 85, whose tolerance for heroin is often so great that the drug must be taken more to avoid pain than to provide a high. But the young, caught up in the mystique of the drug culture and more interested in kicks than cures, have proved less cooperative. "Methadone did the trick," explained a 20-year-old who skipped the counseling at an Illinois treatment center. "The reason I didn't stay on it was that I missed the excitement of using dope. I missed all the glamour of hustling and beating on people."

White Man's Opiate. Dr. Karl Deissler, medical director of Synanon, thinks that methadone alone deprives its users of the will to deal with the problems that led them into drugs. Hassan Jeru-Ahmed, who runs the Black Man's Development Center in Washington, D.C., shares that skepticism. Describing methadone as a "white man's opiate," he uses it to ease withdrawal, not for maintenance. Other critics question the wisdom of allowing an individual to remain dependent upon any drug.

Methadone's advocates answer that whatever its drawbacks, it is far less dangerous than heroin. They reject the notion that dependency is undesirable. Dr. Barry Ramer, whose Center for Special Problems has just won a $121,000 grant from the city of San Francisco, equates methadone with insulin, which some diabetics take daily without suffering social opprobrium. Herman Lancaster of the state-sponsored Illinois Drug Abuse Program stresses that methadone enables the addict "to do what he could never do before." Dr. Robert DuPont, head of the Washington, D.C., Narcotics Treatment Administration, calls total and unassisted abstinence, which is recommended by many methadone critics, a "phony alternative" for heavy users of heroin.

The facts seem to support DuPont's contention. Abstinence, even when combined with extensive rehabilitation programs, has met with only moderate success at best. But the majority of methadone users active in counseling programs have managed to stay off heroin. One California program has lost only four of its 54 participants since it got under way last year. Dole and Nyswander report that 82% of the first 700 enrolled in their program are still participating; 75% are either at school or working. Other programs have recorded similar results.

The significance of their success is social and economic as well as medical. Methadone addicts obtain their drug legally and hence inexpensively. They can work to support themselves. Because most heroin addicts are forced to steal to sustain their habit, they now cost the country about $ 1 billion a year.

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