Successful treatment with methadone maintenance is possible, yet federal and state regulations continue to limit the ability of physicians and other health care professionals to provide methadone maintenance services for their patients. These restrictions fly in the face of studies which show methadone maintenance significantly lowers illicit opiate drug use, reduces illness and death from illicit opiate drug use, reduces crime and enhances social productivity. Compounding the problem of restrictions on treatment are the misperceptions and stigmas attached to heroin addiction, the people who are addicted, the people who treat them and the settings in which services are provided.

Methadone maintenance treatment that works is not a theoretical subject for me. In the early 1970s, I co-directed a small 40-patient methadone maintenance clinic in Boston. In the late 1960s and early '70s, I treated heroin addicts with methadone in my private practice as a general internist and rheumatologist at Beth Israel Hospital in Boston. Certainly none of the other physicians who shared the waiting room of that private outpatient suite would have guessed that on the afternoon that I did an annual exam for a healthy Nobel Laureate, I was also treating heroin addicts in the appointments before and after his.

In those days, it was legal for private physicians to prescribe methadone for addicts and for patients to fill their prescriptions at local pharmacies. Six heroin addicts were integrated in my private medical practice over a three-year period without incident. All but one did very well on maintenance, and each year for nearly 35 years, three of the successful patients let me know that they continue to do well.

Personal experience and statistical data tell me that methadone maintenance treatment for heroin addicts works, but over the past decade, such treatment has lacked support at the highest level. That situation has changed. I recently presented the case for expanding methadone maintenance treatment to a panel of experts convened by the National Institutes of Health. After reviewing the medical literature and hearing from several heroin addiction research experts, the NIH panel reached a consensus which was endorsed by the White House Office of National Drug Control Policy. The recommendations include:

• Require methadone maintenance treatment as a benefit in public and private insurance programs.
  
  
• Eliminate federal and state regulations that act as barriers to treatment. With removal of regulatory barriers, many more physicians and pharmacies could prescribe and dispense methadone, allowing for expanded access through individual physicians rather than in a clinic setting.
  
  
• Find and institute alternative means, such as accreditation, for improving the quality of methadone maintenance programs.
  
  
• Provide education to the public, under federal and state leadership, that heroin addiction is a medical disorder than can be treated effectively and that such an approach yields significant benefits to the individual and society.
  
  
• Assure that funding be sufficient to provide access to treatment for all who require it. The panel strongly recommended that legislators and regulators recognize methadone maintenance treatment to be both cost-effective and compassionate.
  
  
• Teach the principles of diagnosing and treating patients with heroin addiction to all primary-care medical specialists, psychiatrists, nurses, social workers, psychologists, physician assistants and other health-care professionals.

At $20 billion a year, it costs the nation too much to operate under the status quo.