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It is significant that he gave this speech in New York City, home to the largest population of methadone patients in the country, and the city where Mayor Rudolph Giuliani has recently embarked on a one man anti-methadone crusade. Giuliani has vowed to "phase out" the treatment, beginning with those slots which are under the city's direct financial control. Specifically, those serving the poor, the indigent and the incarcerated. Studies show that nearly 90% of people who are forced off of methadone will relapse into heroin addiction. But according to Giuliani, it is immoral to help people off of one addictive substance, heroin, only to "enslave" them with another. Abstinence, he says, is the moral choice. People must be made to live "drug free." And the science be damned.
Is it odd that Rudolph Giuliani rejects science and rationality out of hand in favor of dogma and moral fiat? Perhaps not. Perhaps it is more odd that Barry McCaffrey does not. McCaffrey, after all, has within the past two years rejected syringe exchange and the medical use of cannabis despite firm and growing evidence in favor of both of these propositions. He continues to advocate, even to preside over the continued arrest and imprisonment of adults who smoke marijuana recreationally, despite overwhelming evidence, including numerous government and scientific reports, showing that arrest and imprisonment are more harmful to the user than moderate use. He has lobbied for billions of dollars for interdiction despite the government's own findings that such programs have no impact on the drug trade on America's streets. He has consistently been more concerned with "sending a clear, no-use message" than with the health and well-being of those who his policies affect. So why methadone?
Methadone maintenance is, after all, harm reduction -- that evil phrase that is so often labeled by McCaffrey and his cohorts as a "smoke-screen for legalization." Methadone does not make a person "drug free" -- on that point Giuliani is correct. It simply changes the nature of their use and allows them to live normally, without the destruction attendant to their old addiction. If McCaffrey were true to the principles he espouses on other drug policy issues, he ought to be standing right with the Mayor of New York City, shoulder to shoulder at the door to the clinic, baseball bat in hand, sending his no-use message to America's kids.
The fact is that McCaffrey's position on methadone, like his position on every other drug policy issue, reeks of politics. McCaffrey is in charge of making sure that the drug war continues, that the money continues to flow and the drug warriors stay in business. Plain and simple. But over the past few years their war has fallen into disrepute. Respected people, people with credentials and with access to the media have been publicly questioning the war. And so somewhere, on some issue, there has to be some give. No one who knows anything about addiction would stand for the abolition of methadone on the premise that a "no use" message should be sent. So he takes on Giuliani, in the mayor's own city, and in doing so he makes his war look a little bit more reasonable by comparison.
This week, America's Drug Czar Barry McCaffrey stood up in favor of the expansion of the single most effective treatment for heroin addiction known to modern science. All of us who care about the lives and the health and the futures of the oppressed and the addicted should be happy. It was the right thing for him to do. But we should note that in standing up for rationality, for the lives and the health and the humanity of our society's most vulnerable citizens, in standing up for a reduction in the harms of addiction, he violated every other principle he has articulated during his stewardship of this insane war.
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