L'International Herald Tribune of Europe pubblica un articolo in cui si afferma la superiorita' della terapia al methadone rispetto ad ogni altra cura contro l'eroinodipendenza,

THE WELL-KEPT SECRET OF METHADONE: IT WORKS

by Christopher S.Wren (New York Times Service)

New York - More than 30 years ago, Dr Vincent Dole, a metabolic specialist, and Dr. Marie Nyswander, a psychiatrsit, sought to reverse a worrisome rise in heroin addiction here.

Working at the Rockfeller Institute, as Rockfeller University was then called, the researchers sought to block the craving for heroin by substituing an opioid painkiller developed by German chemists during World War II.

More than three decades later, the synthetic analgesic they first tested in 1964, methadone, is accepted as the closest thing to a heroin cure. About 115000 Americans take it regularly.

Yet by various estimates, only 5% to 20% of such users stay on it for more than 10 years. Some find they no longer want the medication. Others relapse into drug use. Many are put off by the cumbersome, often petty bureaucracy that administer methadone; misleading rumors that methadone is ruinous to health; and an insidious social stigma that, by equating methadone with illecit drugs, forces users to hide the achievement of taking back their lives.

"Successful methadone users are invisible" said Dr. Edwin A. Salsitz, director of the methadone medical maintenace program at Beth Israel Medical centre here. "Methadone is always judged by the failures".

One success story is James Maxwell. With his white beard and twinkling blue eyes, Mr. Maxwell resembles the poster grandpa for a bygone America. He confesses to having turned 80, and remarks, "No granddaughters - very disappointing".

As the hard-driving trumpet player Jimmie Maxwell, he toured with Benny Goodman, performed in the bands of Lionel Hampton, Duke Ellington and Gerry Mulligan, and worked for years as a studio musician on majio radio and television shows.

"I don't think I missed a day of practice in more than 60 years", he said.

But Mr, Maxwell has a dark story to tell. In the prime oh his career, heroin nearly killed him. He has stayed clean by taking methadone every day for nearly 32 years.

His wife of 55 years has nown, of course, but hardly anyone else - not his employers or his neighbors, or his best friend, a retired federal drug agent. "Just for reasons of my career, I did'nt talk about it", he said.

In that he's hardly alone. Because of its association with heroin, those benefiting most from methadone are least likely to risk their careers or reputations by saying so.

The stigma surrounding methadone was analyzed by Herman Joseph, a reserach sociologist who worked with Dr. Dole and dr. Nyswander. Even an innocent yawn, he reported, can jeopardize a methadone user's job if the boss mistakes it as drowsiness induced by methadone rather than routine fatigue.

Yet the eztensive medical literature on methadone does not contain a single report on methadone's failing to block the craving for heroin. "The safety and efficacy of methadone in the treatment of narcotic addiction have been documented more extensively than any ather medication in the pharmacopeia", said Dr. Robert Newman, president of beth Israel Medical Centre.

Regular doses break the heroin user's wild swings between euphoria and withdrawal by stabilizing the level of opiates in the bloodstream. Dr. Nyswander's experience with relapses of detoxified addicts persuaded her that they could not shake heroin without substituing a less harmful narcotic.

"Marie was convinced that addiction was a disease and had to be treated with pharmacoterapy", said Dr. Mary Jeanne Kreek, an early colleague of Dr. Nyswander. Dr. Kreek now heads the Laboratory of the Biology of Addictive Diseases at Rockfeller University.

When the first patients were given up to 80 milligrams oh methadone once a day in double-blind studies lasting eight weeks, she said, "they began turning away from drug administration and getting on with their lives".

Methadone is pratical and effective, Dr. Kreek said, because it can be taken by mouth, its effects are felt gradually and it wears off slowly. Half of it remains in the body after 24 hours. Heroin's euphoric rush lasts only minutes. Minor side effects of methadone, inluding sweating, constipation and a reduced sex drive, tend to disappear.

Still, methadone has its skeptics, like Dr. Mitchell Rosentahl, president of Phoenix House, whose treatment programs strive for total abstinence. Because many addicts abuse multiple drugs and have limited education and job skills, he said, "they are not going to be chemically fixed by giving them another drug".

Dr. Salsitz agreed: "Methadone can't give you a job, or good manners or make you literate". But for healing the medical symptons oh heroin addiction, he equates methadone with what insuline is for diabetics and other medicines are for high blood pressure -