In response to a Washington Post account about a thriving open-air drug market around a Washington, D.C. methadone clinic:

Methadone maintenance is the most effective known treatment for heroin addiction. The medicine is not the problem. Many heroin addicts have been able to return to fully productive lives on methadone and are invisibly among us in our workplaces and neighborhoods.

However, the regulatory framework and the way methadone is dispensed have prevented hundreds of thousands of heroin addicts from getting effective help. Methadone is one of the most tightly restricted drugs in the U.S. because the Drug Enforcement Agency is more worried about possible street diversion of the medicine than how to use it properly for individual patients. The result is continued addiction for many and ready markets for the illicit drugs DEA policy is supposed to stop.

Some clinics, like the ones mentioned in this story, are just dispensing mills that do not address the complex medical, psychiatric and social problems of their clients. They, not the parking lots next door, should be the first focus of reform. Repeated studies have shown that large methadone clinics often provide doses that are too small to be effective for the heroin addiction they are supposed to treat, and virtually no care for the medical, mental and social problems of their clients

We can do better. Clinicians in office-based or small group practices should be allowed to provide methadone and a new drug called buprenorphine-naloxone as part of their therapy, just as they do in Great Britain and other countries. Then there will be no concentrations of vulnerable people to provide a base for open air drug markets. And, the individual clients can get the medical and other services they need to get and stay well.

David Rosenbloom is Director of Join Together