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BEEN THERE, DONE THAT (NEW: Sept 5) By Robert Newman, MD There have been recent calls for elimination of methadone "take-home" doses ("carries") to end the black market in the medication. As in the case of illicit drugs such as heroin and cocaine, however, addressing the supply while ignoring the reality of the demand is futile - and costly! A paper* written three decades ago describes what happened in Boston, Mass., when take-homes were stopped. At the start of January 1972, 279 patients were enrolled in the Boston City Hospital methadone program when it was announced that all take-home medication would be eliminated shortly. Between January and March, an average of 10 patients left treatment each month. In April, when the no-take-home policy was initiated, the number jumped five-fold, to 49 (18% of the total patient population). By February, 1973, ten months after the policy was changed, only 43% of those enrolled in December of 1971 remained in treatment. Furthermore, among the 279 patients enrolled at the end of December 1971, 73% were employed; in February 1973, only 39% were employed. The article quotes Dr. Vincent Dole, co-founded of methadone maintenance treatment, as having written (before the Boston policy took effect): "On the face of it [eliminating take-home medication] sounds like a very conservative way to do things. But it will prevent you from treating any one person very long. . . . If you have to make a detour to some downtown clinic every day of your life to take some medicine, you probably won't have a job long and socially speaking you are totally disabled. " Thirty years later, those who advocate the same simplistic means of addressing the illicit traffic in methadone would do well to heed Dr. Dole's warning. An entertaining way to learn the same lesson would be to watch the famous post-World War II movie, The Third Man. The film is based on the lethal black market in penicillin in Vienna. How was that problem ultimately solved? Not by curtailing supply of the "wonder drug," but the very opposite: making it available legally and safely to all who want and need it. * Patch V at al: "Patient retention and employment patterns subsequent to cessation of "take-home" privileges in a methadone maintenance clinic."
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