“For the first time, help comes from the doctor’s office, not the methadone clinic.”

An article on Buprenorphine appeared January 24, 2006, in USA Today, with the above byline.

The availability of opiate-agonist maintenance treatment through prescription by office-based practitioners is a welcome and long-overdue development, even though the rationale for limiting the prescription-writing authority exclusively to Buprenorphine is not clear. What is distressing, however, is the apparent equanimity with which even the most knowledgeable experts in the field view the shortcomings of the government-designed and government-controlled system that has constrained methadone maintenance for the past four decades. That system is summarized by the news article in the following quote: "People who would never come to a methadone clinic, because it is both degrading and stigmatized, will come to a private physician’s office.”

This highly pejorative assessment of methadone maintenance facilities undoubtedly has some basis in fact. For sure, it reflects the perception of most Americans – and it would appear to be shared by Charles Schuster, to whom the quote is attributed. Schuster, however, is a former Director of the National Institute on Drug Abuse, and – along with virtually all of his colleagues in Government before, during or after his tenure – bears responsibility for the way in which methadone treatment is provided. What has he – and what have other leaders in the field of drug abuse treatment – done to lessen the degradation and stigmatization of “clinics”? Even now, as Schuster applauds the availability of Buprenorphine in private doctors’ offices, he seems to have zero concern over the roughly 200,000 patients who receive methadone under the only circumstances allowed by law.

The Government’s control over the facilities that offer methadone maintenance is absolute, and operating authority can be revoked for failure to adhere to any of the myriad rules, regulations and “standards” which apply. Why are degrading practices tolerated (in fact, many are required!)? What has Schuster done to lessen the stigma surrounding methadone treatment? What have other government, academic or clinic leaders in the field done? The most generous answer has to be, “Not enough!”