| About Us | Addiction Treatment | Special Patient Groups |
Information by Country |
In the News | Resources and Events |
Frequently Asked Questions |
July 19, 2001
It's not immediately obvious that Dr. Edwin Salsitz is at the center of a revolution in medicine. His patients are unremarkable in appearance — indistinguishable from the others waiting in a Manhattan practice for appointments with their internists. Nor would any casual observer find anything unusual about the office visits themselves: assessments are performed, tests ordered, referrals made, and medication prescribed.
What makes this scenario remarkable is precisely the fact that it's all so unremarkable. For these are methadone patients - formerly heroin addicted — and since 1919 it has been illegal for private practitioners to provide this treatment. It was in that year that the Supreme Court ruled it a crime for physicians to prescribe maintenance opioids for anyone determined to be addicted. Fifty years later the government responded to the challenge of a small group of courageous MDs by permitting maintenance with methadone, but only within heavily regulated, centralized clinics. This quiet scene at Dr. Salsitz's office represents one of the first instances in more than 80 years of private physicians in the United States legally maintaining opioid dependent users.
Dr. Salsitz directs the medical maintenance program at Beth Israel Medical Center in New York City. In collaboration with other physicians, he treats more than 200 long-term, stabilized methadone patients in an office-based setting. Patients meet with their medical maintenance physician approximately every four weeks and receive a month's supply of methadone in a tablet form.
Medical maintenance was developed with two primary aims: to mainstream patients and to mainstream the treatment. Achieving the former entailed freeing patients from a system that makes it exceedingly difficult to lead a normal life. Achieving the latter required finding physicians willing to free themselves from their own prejudices, and getting approval of a variety of governmental agencies at the federal and state level.
The medical maintenance program was started by Drs. Dole and Nyswander at Rockefeller University in 1983. They received special permission (pursuant to an IND - Investigational New Drug-application) from the FDA so patients who were doing well could receive a month's worth of methadone to take home. In 1985 Dr. Dole transferred that IND to a group of internists at Beth Israel.
Dr. Dole wanted patients cared for in ordinary medical practices, and for this reason he selected physicians with no background working in methadone clinics, and therefore no preconceived biases.
For the patients fortunate enough to have access to this program, state-of-the-art care is provided in a private office setting, delivered with the respect, confidentiality and professionalism to which all patients are entitled. Patients are seen alongside all other patients cared for in the generalists’ offices.