DEALogo DRCNet Response to the
Drug Enforcement Administration

METHADONE MAINTENANCE IN THE 1990's: A REPORT BY THE DRUG ENFORCEMENT ADMINISTRATION, OFFICE OF DIVERSION CONTROL

March, 1995

DEA Statement Response
Introduction  
Since its inception in the early 1970's, methadone maintenance as a treatment for narcotic addiction has been controversial. The medical and scientific communities have had differing opinions regarding optimum treatment modalities. Alternative drugs to methadone have been sought. The location of treatment programs has caused controversy, with communities resisting the establishment of methadone facilities in their midst. And the role of the Federal government in narcotic treatment has been debated. Despite these controversies, there is evidence to suggest that well-run programs have produced a significant measure of improvement in the social adjustment of patients even though they remain drug dependent. Yes, there certainly is evidence to suggest that these programs work.   See, for example,
But also not in question is the fact that diversion of methadone from many treatment programs is a serious problem and that every year medical examiners report hundreds of deaths in which methadone was involved. Yes, actually, there is quite a question how serious a problem this really is.  The DEA is claiming a crisis -- requiring more power and money for them --off of a few hundred deaths per year, with nary a thought to the 500,000+ killed each year by alcohol and tobacco.
These data, taken together with actual case investigations and street intelligence collection, provide convincing evidence that regulatory requirements need to be strengthened and enforced. As Professor Charles Whitebread has pointed out, this is the same old pattern of a perceived crisis, along with the same old knee-jerk response -- tougher enforcement.  There isn't even a thought to any other possible approaches.
Role of the DEA  
Federal policy seeks to balance methadone's risks and benefits. Clearly, the need for responsible, medically supervised narcotic addiction treatment must be balanced with the need to closely supervise and monitor the availability of a drug with high abuse liability. Federal policy seeks to regulate purely medical matters with poorly trained cops.  The cops don't have any wonderful stories to tell about their successes unless they bust somebody.  This is directly contrary to the legitimate interests of legitimate doctors and patients of all types.
Methadone maintenance therapy is generally regarded by Federal health authorities as a legitimate form of medical treatment for certain drug dependent persons as an adjunct to a comprehensive program of therapy. As in other areas of medical practice involving narcotic drugs and controlled substances, the Drug Enforcement Administration (DEA) is not responsible and does not possess the authority to define legitimate medical practice. They can define legitimate medical practice simply by making a phone call to a doctor and threatening to pull his license to prescribe all drugs.  They can summarily put doctors out of business for anything they don't like, without due process of law -- and they have done it.  One of the best examples is their threats against doctors who recommended medical marijuana in California after the passage of Proposition 215.
Nevertheless, because of the nature of the drug involved, and its history of abuse and in the illicit traffic, DEA does have the responsibility of determining which measures are required to safeguard against methadone diversion and ensuring that they are enforced. In other words, the DEA is clearly interfering in the definition of legitimate medical practice.
In most cases, this diversion arises as a result of negligent practices or inadequate management of what may otherwise constitute legitimate activity. In other cases, a program may be established and operated in such a way that it becomes merely a cover for the sale of drugs to persons who apply as "patients" but in fact neither seek nor receive rehabilitative services. In the case of United States v. Moore, 423 U.S. 122, 96 S.Ct. 335 (1975), the Supreme Court upheld the authority of DEA to take action in such cases. The DEA picks the most extreme examples of pill pushing to justify their cases, while they ignore decisions which went against them, such as Linder v. US.
These problems appear to be increasing as a result of inadequate enforcement of standards and the spread of private programs for profit. The lucrative nature of such businesses is definitely attracting individuals with little or no commitment to bona fide treatment. For example, in a recent case in Pittsburgh, an individual seeking to register to establish a methadone program was arrested as a key figure in a large interstate marijuana trafficking conspiracy. Although most medical authorities concede the need for some controls, many feel that the problem of diversion and traffficking and report of methadone-related deaths do not warrant even the current level of control. The resulting ambiguity of policy may be encouraging opportunists without interest or intention to provide bona fide treatment to enter the field for profit. It is clear from the DEA's own statements that there are only a few hundred deaths per year from methadone -- fewer than the number who die from aspirin or Tylenol, for comparison.  This clearly does not justify the DEAs repressive control of medical care.

 
Background and Legislative History  
Methadone hydrochloride is a Schedule II synthetic narcotic analgesic with actions quantitatively similar to morphine or heroin. The principal therapeutic uses of methadone are analgesia and sedation, and the detoxification or maintenance of narcotic addicts. The vast majority of methadone produced in the United States annually--3,970 kilograms in 1994--is sold to narcotic treatment programs. Methadone is also a highly effective medication for severe chronic pain.   The reason it is sold primarily through narcotic treatment programs is because of the DEA's abusive policies against legitimate pain patients.
Federal regulations providing for the use of methadone for narcotic abuse treatment, in particular heroin abuse, came into effect in 1972. These were promulgated by the Food and Drug Administration (FDA) following a joint review with DEA's predecessor agency, the Bureau of Narcotics and Dangerous Drugs. We invite you to read the sordid history of the creation of the DEA in the Nixon White House.  In short, the modern DEA is the last remaining remnant of Nixon's Watergate conspiracies.  See Agency of Fear.
By 1972, there were over 65,000 addicts in 450 methadone maintenance programs in the U.S. Today there are approximately 115,000 patients being treated at 950 methadone facilities. Because the use of methadone to treat addicts was originally regarded as experimental, programs were originally federally registered as researchers. But the number of people involved and the scope of the programs soon far exceeded anything permitted under the concept of research.  
Thus, the Narcotic Addict Treatment Act of 1974 (NATA) was enacted as an amendment to the CSA in order to establish standards of practice and control for the methadone maintenance programs. The legislation provided for the registration of such programs under treatment standards established by the Secretary of Health and Human Services and control standards established by the Attorney General (i.e., the Drug Enforcement Administration, or DEA). The law provided the framework for DEA investigation and registration of treatment programs. For the first time, DEA was given authority to mandate specific security and record keeping requirements for treatment programs and to revoke registration for violations of same. The agency conducted a preregistrant investigation of each program prior to registration, and once registered, each program is scheduled for an in-depth accountability investigation every third year as part of DEA's cyclic regulatory investigations program. This practice continues today. Another DEA responsibility with regard to methadone is the establishment of annual production quotas for this Schedule II drug.  
Methadone Diversion  
In addition to its responsibilities regarding registration of treatment programs and enforcement of regulations regarding record keeping and security, DEA' s legal mandate under the CSA confers upon the agency the responsibility to curtail methadone diversion. The evidence supports the view that methadone diversion is primarily the result of lax program administration, a view that has been reiterated in many quarters for many years. When compared with the problems of alcohol and tobacco, the problems caused by methadone are trivial, and are far outweighed by the benefits that methadone brings both in the treatment of addiction and chronic pain.  The DEA's policies toward methadone kill more people than the drug itself.
There is little disagreement that methadone is primarily diverted by treatment clients. Frequently it is clients' take home doses of methadone which are sold on the street. One study (Spunt et. al., 1986) classified types of diverters among treatment clients and the buyers of diverted methadone. The diverters included "Merchants," polydrug users who regularly sell their methadone for additional income. The buyers included "Street Addict Euphorophiles," who use methadone for its euphoric effect; and "In-Treatment Double-Dosers," who buy extra methadone for the euphoric effects gained from "double dosing." The latter were found likely to be users of other substances in addition to methadone. This study found that 13 percent of narcotics users not in treatment were methadone addicts whose primary drug of abuse was methadone, used for its euphoric properties. By the DEA's own statements, methadone kills a tiny number of people, particularly when compared with much bigger killers like alcohol, tobacco, and aspirin.  

 
This study discussed the policy implications of methadone diversion and concluded:

"Methadone diversion continues to be an area of concern for several reasons. First, methadone is a highly potent opioid whose use produces addiction and, in narcotic naive individuals, can produce death.

By the DEA's own statements, there are not a lot of deaths attributable to methadone.  Aspirin is a bigger killer.
Its addition to the battery of drugs already available for abuse is not a welcome one. Secondly, the availability of methadone outside of treatment may discourage addicts from entering treatment and extend the length of their addiction...the addict buying methadone illegally is able to stay one day more out of treatment...there is...a clinical and administrative need to establish limits and to monitor patient urines carefully and frequently as well as to clearly present these limits and the results of positive urinalysis to clients." (580-582) Methadone is a valuable medication for the treatment of severe chronic pain as well as for addiction.  It allows many pain patients and addicts to essentially regain normal lives.  See the references listed above.
Some have argued that methadone is unnecessarily the most tightly controlled of all Schedule II drugs, and that there is no compelling medical reason for such stringent control (Institute of Medicine, 4). However, from the standpoint of controlled substances diversion, the dispensing to an addict population of an addictive, euphoria-producing drug with a high street value demands particular vigilance. It should only occur within a well regulated therapeutic framework. This is simply the DEA's attempt to justify their own interference in what really are medical matters.  They have no business dictrating the legitimate medical use of any drug, including methadone.
In 1988 DEA conducted an undercover investigation in five boroughs of New York City to document methadone diversion. Ninety eight bottles of the drug were purchased, which contained a total of about five and one half grams of methadone. Dealers from whom the drug was purchased refused to give up the bottles in which the methadone was originally dispensed, so that they could obtain more of the drug from the clinics. The "buy" money used in this undercover operation was depleted before all of the diverted methadone available at these sites had been purchased. Note that the DEA conducted a major investigation in five boroughs of New York City, at some tremendous cost, to seize a grand total of five and one half grams of methadone.  We don't need a major Federal agency to spend millions of dollars hunting down five and one half grams of methadone.  The money would be better spent on more drug treatment.
As the following case examples demonstrate, methadone does find its way into the illicit market by means other than diversion by treatment clients.  
A physician practicing in Washington, D.C. posted flyers in the city advertising that inexpensive methadone was available (starting at fifty cents per milligram), with no urine testing requirements or treatment program attendance. In more than a dozen undercover buys of methadone, this physician dispensed methadone without conducting a physical examination. His DEA registration was subsequently revoked. This physician was clearly an idiot.  For another view of what the DEA is really doing, see Deadly Morals.
A veterinarian in Florida wrote methadone prescriptions for his dog, had the 10 milligram/100 dosage unit prescriptions filled, then sold the methadone to drug users. He voluntarily surrendered his DEA registration.  
An Ohio physician was known to prescribe 10 milligram methadone tablets to known narcotic addicts and abusers, outside the scope of legitimate medical practice. An undercover buy of a methadone prescription was made at the doctor's office with no initial examination. This physician subsequently surrendered his DEA registration. The DEA has no business determining what is outside the scope of legitimate medical practice.  see Deadly Morals.
Methadone Treatment and Continued Drug Abuse  
The serious problem of continued drug use by methadone treatment clients has been acknowledged for many years. Clients who use cocaine are more likely to divert methadone, and to continue to commit crime to finance their cocaine purchases. (Spunt, 1986) By focusing on relatively small problems, the DEA conveniently ignores the fact that methadone provides numerous benefits to both addicts in treatment, and to society as a direct result.
Those who continue to use heroin also are more likely to divert methadone and use cocaine. (Spunt, 1986; Dunteman, 1992) The fact remains that their condition overall is considerably better because of methadone.
This also is a concern in regard to the transmission of HIV and AIDS, which has been offered as a justification for the rapid increase in number of treatment programs in the past decade. Methadone treatment has been presented as socially beneficial in that it reduces crime committed to finance heroin habits, and reduces transmission of the virus and disease through the substitution of methadone for the needle. However, the documented increase in cocaine use, which also often involves injection by needle, and abuse of other drugs such as marijuana and benzodiazepines by methadone clients, is of serious concern and must be addressed. The DEA just said nothing.  It started out talking about HIV and AIDS, and then wanders into benzodiazepines (Valium), and marijuana, which have nothing at all to do with the AIDS problem.  They end by saying these problems "must be addressed."  Of course, the DEA only knows one method of addressing any part of the drug problem - prisons.
It is clear that program regulations must be strictly adhered to if this problem is to be defeated. Urinalysis must be conducted regularly, and individuals who test positive for drugs or negative for methadone must be disciplined or eliminated from the program. The DEA is tilting at windmills. On pitifully small statistics, against a record of methadone's clear benefit to both pain patients and addicts, they argue that they are the judges of treatment progress - not the medical profession.
There is no incentive for compliance with program requirements such as no drug use if clients know that noncompliance has no consequences. Sure there is.  It is called "getting your life back together."
This also points to the need to severely curtail, at a minimum, the availability of diverted methadone. The DEA plainly hasn't presented the evidence to prove the case that there is even a serious problem with diversion, let alone a major need for more Federal action.
Treatment clients are robbed of incentive to stay drug free if they know they will not be removed from the program for drug use, and if removed, that there is always methadone available from street sources. The DEA thinks the only incentive is fear.
Methadone Treatment Controversy  
Over the past two and a half decades, narcotic treatment programs have rehabilitated many former heroin addicts and users via methadone pharmacotherapy and comprehensive counseling, psychiatric and health services. This is true.  It is obvious that the benefits of methadone far outweigh any problems it may cause. 
However, methadone maintenance has been, and continues to be controversial for a number of different reasons. Detractors of methadone maintenance, who frequently favor drug-free recovery from addiction, contend that methadone maintenance is not treatment for narcotic addiction since clients remain dependent on a narcotic. They also argue that methadone treatment alienates clients from drug-free recovery resources, and that individuals on methadone maintenance often switch to or continue to abuse other drugs, most often alcohol, marijuana and cocaine. There has been and continues to be differing practice regarding methadone dosage and length of treatment. It should be noted that the DEA thinks "drug free" is the only criteria of successful drug treatment, and any client who fails to remain drug free is a failure and must be punished.  They fail to note such basic items as a reduction in crime, an improvement in the ability to hold a job, and reduced AIDS infection can also be significant factors in successful drug treatment.  For another view of how addicts can be treated, see Rx Drugs, the Liverpool Approach.
Inadequate Service in Narcotic Treatment Programs  
The issue of inadequate and poor quality service in treatment programs has been acknowledged for many years, and is closely associated with the problem of methadone diversion. The fact is that there exists a great disparity in the quality of service offered by various treatment programs (D'Aunno, 1992). The problem of methadone diversion is particularly associated with the proliferation of for-profit clinics, some of which do no more than dispense methadone and collect payment for it. This problem has continued for years, with grave health consequences. The only grave health consequence is the addiction itself, which is easily managed in a medical environment.
In congressional testimony recorded over 20 years ago, regarding the need for the Narcotic Addict Treatment Act of 1974, Senator Birch Bayh stated:

"The subcommittee found that far too many programs had substituted the dispensing of methadone and the collection of urine for treatment and rehabilitation. The emphasis should be on the quality of services and not merely the number of persons processed. Reliance on the drug as a simple, inexpensive answer to heroin addiction is ill-conceived and will lead to assembly line programs with all their attendant problems, not the last of which is the diversion of methadone for illegal purposes."

  
Four years later, the House Select Committee on Narcotics Abuse and Control issued a report of its findings after examining the city of Boston's experience operating a methadone maintenance and detoxification clinic at a city hospital. In its recommendations, the Committee stated: "The Select Committee believes that treatment of addiction via methadone represents a skilled sub-specialty of medicine and not merely a branch of community medicine or psychiatry." Also: "The Select Committee recommends that auxiliary services become a fact in every methadone clinic and not be more a theoretical than actual entity." The Committee staff further concluded that: "A relationship exists between the overall quality of clinic management and the likelihood of a variety of patient abuses, including methadone sales."  
In 1990, Mark Nadel, the Associate Director for National and Public Health Issues of the General Accounting Office's (GAO) Human Resources Division, testified before the House Select Committee on Narcotics Abuse and Control on the results of a study of methadone maintenance programs (General Accounting Office, 1990). The GAO found that program policies, goals and practices varied greatly; many programs were not effectively treating heroin addiction, with a substantial percentage of patients still using heroin after six months of treatment; all but one of the 24 programs reviewed did not know their program's effectiveness; and there are no Federal treatment effectiveness standards for programs.  
It also found that merely administering methadone, with no administrative, counseling, or rehabilitative services, is not effective in reducing intravenous drug use. The GAO recommended as a result of the study that the Secretary of Health and Human Services 1) develop performance standards for programs, 2) give guidance to programs regarding data collection so that NIDA can assess program performance, and 3) increase program oversight. While there are certainly things which can be improved in these programs, those problems do not constitute a justification for the DEA's repressive approach.   Regardless of the problems in methadone addiction programs, that is no excuse to deny methadone to pain patients.
A national study of methadone treatment practices (D'Aunno, 1992), the results of which were published two years after release of the GAO report, determined the positive impact of government regulation of narcotic treatment programs. The study found that "...the weight of current evidence suggest that methadone treatment units that restrict dose levels and client participation in treatment are counterproductive both for reducing illicit drug use and for preventing HIV infection among needle users...Units that have larger profit margins also have lower average dose levels. Units that are high in service intensity (i.e., provide more services to their clients) have fewer clients who are receiving decreasing dose levels...Government regulation is related to two aspects of treatment: the more that units report their practices are influenced by government regulation, the higher their dose limit and the higher their average dose level..it is important to point out that time in treatment is significantly related to dose level. Units that have higher average dose levels are more likely to have clients who remain in treatment." (253-257) The study concluded: " [T]he role of government regulation is important. Units with higher dose limits and higher average dose levels are more likely to report that their dose practices are influenced by government regulation. This correlation is, however, difficult to interpret. It may indicate that government regulation promotes more effective treatment practices." (257) Government regulation is different that DEA repression.  The DEA's tactics against doctors are an obscenity.  See Deadly Morals.
The IOM Study  
In 1992 the Institute of Medicine (IOM) was requested by the U.S. Public Health Service to evaluate Federal narcotic addiction treatment standards and the regulation of methadone treatment programs pursuant to those standards. The IOM convened a Committee on Federal Regulation of Methadone Treatment for this task. The study was supported by NIDA and the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration. The FDA participated in monitoring the study.  
The Need for Controls  
The committee produced in December 1994 a detailed, lengthy report entitled Federal Regulation of Methadone Treatment (Committee on Federal Regulation of Methadone Treatment, 1994). Once again, this study points out the need for comprehensive drug treatment programs of which methadone administration is merely one element (195). It concludes that "There is little evidence that...the provision of methadone by itself can lead to reductions in other important problem areas of nonopiate drug use, alcohol dependence, unemployment, psychiatric problems, and disproportionate use of health care services." (199) It recognizes the problem of poor quality treatment programs, stating "[T]he committee believes that [it] is necessary for an effective enforcement effort to close seriously deficient programs. The committee does not subscribe to the proposition that any program is better than none." (12) And it recognizes the need for treatment program oversight: " [A] need exists to maintain certain enforceable requirements in order to prevent substandard or unethical practices that have socially undesirable consequences. " (5) On these points, DEA is in general agreement with the committee's findings.  
Majority and Minority Views  
This report reiterates many of the findings of other researchers and policy makers: that substandard treatment program exist, that lax program administration in such programs and others commonly leads to methadone diversion, the importance of adequate dosage levels of methadone are vital, and that successful narcotic treatment involves extensive support services and not merely the dispensing of methadone. But the committee's and DEA's views diverge on solutions to improving the effectiveness of narcotic treatment. Although not recommending abolition of methadone regulations, the committee advocates "a careful readjustment of the regulatory controls," (31) including a large extension of take-home privileges. It should be noted here that the best study of the methadone problems to date found that the DEA's policies are not reasonable. 
A majority of the committee recommended patient eligibility for medical maintenance after one year of treatment, where the "best" patients would be allowed a maximum 31 day take-home supply of methadone. DEA strongly believes such an allowance excessive, and agrees with the minority of the committee, which felt existing regulations should be retained in order to "...pace the progress of patients in relation to reasonable expectations, to minimize opportunity for malpractice by unscrupulous physicians, and to maintain the credibility of treatment programs that could easily suffer from the behavior of a few such individuals." (200)  
The committee further found that "...current policy puts too much emphasis on protecting society from methadone, and not enough on protecting society from the epidemic of addiction, violence, and infections that methadone can help reduce." This is a polite indictment of the DEA's policy.
Although these are admirable goals with which everyone agrees, poorly controlled programs may actually become a source of the very ills which they are designed to prevent. This is a good description of the DEA's own programs.  We estimate that 7,000 pain patients commit suicide every year because of the lack of legitimate pain medications such as methadone.  The DEA's policy clearly kill more people than the drugs themselves.
DEA has found in many narcotic treatment programs a disregard of test results that are positive for drugs and/or negative for methadone. The latter clearly indicates methadone diversion. With no consequences for not adhering to program rules, there is no incentive, particularly in less-motivated treatment clients, to succeed in the treatment. The DEA thinks that the only motivation for improving in drug treatment is fear.
Death Statistics  
A very serious concern about methadone, which has persisted for many years, is the fact that every year a significant number of deaths involving this drug are reported by medical examiners across the country. These coroners' reports are merely a barometer of what is occurring nationwide with regard to drug-related deaths. In view of the high degree of precision involved in coroners' drug analyses, these reports can be considered an accurate gauge of which drugs are associated with the most serious health consequences in the general population.  
Analysis of national methadone-related deaths reported by the DAWN system during this decade reveals startling information on the danger of this drug. In 1990, there were 441 methadone-related deaths reported by medical examiners, and 2,009 heroin deaths--a ratio of one methadone-related death to every five involving heroin. In New York, the ratio was one to two. In 1992, there were 344 deaths that involved this drug, over 40 percent of which occurred in the New York area. A comparison with the number to deaths involving heroin, a total of 2,889 in 1992, reveals that there was one methadone-related death nationally to every eight related to heroin. In New York, the ratio was one to four. This data is remarkable, considering that methadone is probably the most tightly controlled drug in the United States. This data is remarkable when compared with 400,000 deaths from tobacco, and more than 100,000 from alcohol.  Even if the DEA wiped methadone off the face of the earth, it wouldn't even mean a single percentage point reduction in America's drug problems.
The data for 1993, the most recent year for which complete data is available but which has not yet been publicly released, reveals that these ratios changed considerably as a result of a significant increase in heroin deaths. These statistics pose a number of questions which have remained unanswered for years. It is curious that no serious attempts have been made to determine whether these individuals whose methadone-related deaths are reported by medical examiners are enrolled in one or more treatment programs, or whether they obtained the methadone from diverted supplies. In either case, a serious issue may be involved. The issue is not nearly as serious as the problems the DEA is causing by its own interference with legitimate medical practice.
Over the years, these concerns have been dismissed, and those publicizing concerns have been accused of opposing narcotic treatment and methadone pharmacotherapy. The DEA is clearly opposed to narcotic treatment and methadone therapy. They earn their promotions from busting doctors, not from insuring that pain patients and addicts get adequate treatment.  That has been the entire history of the US anti-narcotic agencies. 
The problem has been downplayed on the grounds that the decedents are for the most part presumed not to be narcotic treatment clients, and the methadone involved in the deaths was bought on the street and taken without medical supervision. If so, then an even more serious problem of diversion is evident. Here the DEA is again campaigning for more power, more money, more toys, and more agents -- because there is a crisis because about 400 people die from methadone in a typical year.  The 400,000 deaths from tobacco, on the other hand, do not constitute a crisis of interest to the DEA.
Also it is pointed out that in these deaths frequently more than one drug is present, therefore it cannot be determined whether methadone caused the death or was a contributing factor. Whether the methadone involved in these deaths was obtained illegally, i.e. from "street buys," or legitimately from a treatment program, or whether the methadone was the primary cause of death or a contributing factor, the case for strengthening controls is indicated. Methadone diversion must be prevented, and program clients must receive effective treatment and monitoring to discourage and prevent abuse of other drugs while under methadone treatment.  
DEA Cases  
DEA assesses drug problems by looking at indicators, such as DAWN data, and by field experience. Ample cases have been reported in which rampant methadone diversion was occurring or outright illegal dispensing, and from which undercover officers had no problem making street "buys." The cases reflect the incidence of poorly administered programs and the high illicit demand for methadone. Once again, they demonstrate the need for treatment program regulations and their strict enforcement. The following are recent case examples: For another view of the DEA's cases, see Deadly Morals.
In late 1994, officials at a New York Veterans Administration (VA) clinic advised DEA of methadone diversion in and around the clinic. Surveillance established that a "market" of methadone buying and selling was occurring at the clinic entrance. It was apparent that numerous patients were selling their take-home dosages which were dispensed on Fridays. At the time of his arrest, the main subject of this investigation, who had sold a VA agent more than 15 bottles of VA take-home methadone, was selling methadone not from the VA facility, but which had probably come from an armed robbery of a private treatment program. As a result of this armed robbery, in excess of 11,000 40mg. methadone tablets and 460,000 mg. of methadone hydrochloride powder were stolen.  
In November 1994, a Michigan psychiatrist was arrested after delivering 40 controlled substances prescriptions to an undercover agent. He obtained the prescriptions from a narcotic treatment program where he was employed. He used the profits from his prescription sales (five previous undercover buys were made from him) to purchase heroin for his personal use. A regulatory investigation 18 months earlier of the clinic which employed this physician revealed numerous record keeping, accounting and security violations.  
In another case, it was discovered that a subject arrested in late 1994 for involvement in a multi-ton marijuana smuggling organization had a pending DEA application for registration to open a methadone clinic in Pennsylvania. One of the original clinic incorporators, it was further determined, was a former heroin addict with a multiple arrest record.

 
In a 1992 case in Texas, information from state and local law enforcement and the FDA supported allegations of, and an undercover operation resulted in illegal methadone dispensing at a physician-owned treatment program. An accountability investigation of the program revealed significant methadone shortages. Based on allegations that methadone was being dispensed by an addict at a second Texas clinic owned by the same physician, an investigation was conducted and many of the same violations found at the second clinic. The physician agreed to the revocation of his treatment program registrations and agreed not to reapply for registration in future.  
Conclusion  
The treatment of narcotic addiction is a health issue. Correct.  It is not a matter where poorly trained cops should be running the show and setting the standards.
It is disturbing that treatment practices which have been determined to be least successful, i.e., nothing more than the dispensing of methadone to clients with no other services provided, are frequently associated with clinics which operate for profit. As reported in the IOM study and in previous studies over the past two decades, successful narcotic treatment programs include counseling, health and rehabilitative services in addition to methadone treatment. In attempting to expand treatment availability in response to the recent rise in heroin use and the spread of HIV and AIDS, these services are being cut back. To reiterate the IOM committee's statement: "The committee does not subscribe to the proposition that any program is better than none. "  
At present, most authorities agree that there is a role for methadone in the treatment of narcotic addicts. Within its purview of regulatory and law enforcement responsibilities, DEA supports the establishment of legitimate methadone programs as well as research efforts to seek viable alternative treatment drugs, as it has with LAAM. But the history of addiction treatment confirms the need for adequate regulatory and law enforcement involvement in the process. This is supported by public health data on reports of methadone overdoses and deaths over the past two decades. Tight controls must be imposed where dangerous drugs with high street value are being provided to individuals known to abuse drugs, and these controls must be enforced. DEA is committed to fulfilling its responsibility in the enforcement of necessary controls and is working with the FDA, NIDA and other Federal health agencies represented on the Interagency Narcotic Treatment Policy Review Board to find solutions to these problems. As always, the only approach the DEA knows to any drug problem is more punitive measures.  It is their inability to consider any alternative approaches which is the real problem.

 

References

Barrett Drue H., Luk Andrew J., Parrish Gib, Jones T. Stephen. 1993. Medical Examiner Cases in Which Methadone Was Detected, Harris County, Texas 1987-1992. Unpublished report. Atlanta. Centers for Disease Control and Prevention.

Chambers Carl D., Brill Leon B., eds. 1973. Methadone: Experiences and Issues. New York: Behavioral Publications, 171-176.

Cooper James R. 1992. Ineffective Use of Psychoactive Drugs: Methadone Treatment is No Exception. JAMA 267:281-282.

D'Aunno Thomas, Vaughn Thomas E. 1992. Variations in Methadone Treatment Practices: Results from a National Study. JAMA 267:253-258.

Dunteman George H., Condelli Ward S., Fairbank John A. 1992. Predicting Cocaine Use Among Methadone Patients: Analysis of Findings from a National Study. Hospital and Community Psychiatry 43(6): 608-611.

General Accounting Office. 1990. Methadone Maintenance: Some Treatment Programs are Not Effective. Washington, D.C. (GAO/T-HRD-90-19): Government Printing Office.

House Select Committee on Narcotics Abuse and Control. 1978. Methadone Diversion. Washington, D.C.: Government Printing Office.

Institute of Medicine, Division of Biobehavioral Sciences and Mental Disorders, committee on Federal Regulation of Methadone Treatment. 1995. Federal Regulation of Methadone Treatment. Washington, D.C.: National Academy Press.

Manber Malcolm M. 1981. Methadone. Medical World News: 50-66.

Senate Congressional Record, May 1, 1974. Washington, D.C.: 6705-6706.

Spunt Barry, Hunt Dana E., Lipton Douglas S., Goldsmith Douglas S. 1986. Methadone Diversion: A New Look. The Journal of Drug Issues, 16(4): 569-583.

Donald R. Wesson, "Editorials." JAMA, 10 June 1988, 259(22):3314-3315.

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