The primary concern of the DEA is to minimize illegal diversion of methadone
to the street. The DEA requires programs to provide substantial security to deter
theft of methadone, to limit access to methadone to authorized individuals, to
monitor methadone ingestion, and to account for dosage by individual. The
process to obtain approval to dispense methadone is painstaking and resulted in
implementation delays for projects initiating new methadone treatment pro-
grams.

State rules govern Medicare/Medicaid eligibility, including the level and du-
ration of public assistance for treatment. Because of the ability of the research
demonstration grants to provide independent support for drug abuse treatment
costs, state rules and regulations regarding drug abuse treatment financing were
not problematic for the research demonstration projects. However, state and local
treatment funding tends to support minimal levels of treatment, a trend likely
to continue under state-managed care reforms.

Drug abuse treatment has been shown to provide cost benefits in terms of
reduced drug use and trafficking, reduced crime, and reduced incidence of AIDS
and other infectious diseases. Both because of these benefits and as a simple
humanitarian response to a serious public health problem, there is a clear na-
tional need to provide adequate treatment for drug abusers. However, illicit drug
users, even those in treatment, are an unwanted population. Many persons fear
that drug abuse treatment programs located in their community will result in
loitering, increased crime, and reduced property values. The location of treat-
ment programs for drug abusers in or near residential neighborhoods is thus
usually quite controversial, even if the primary clientele for the treatment pro-
gram are likely to be drawn from the neighborhood.

Zoning rules at the local level limit where programs can be sited. In most
local jurisdictions, drug abuse treatment facilities must be in a zone approved
for health care facilities. Siting a new program may involve a zoning change
and an opportunity for vocal community representatives to oppose the new pro-
gram. Local opposition to required zoning changes or variances can effectively
preclude the establishment of drug abuse treatment programs in prospective sites
not already so zoned.

Community opposition resulted in more than one project's having to abandon
its preferred site and seek alternative locations. Support for new treatment fa-
cilities was most often gained through persistence and hard work. Investigators
setting up new programs held a number of meetings with city officials and
neighborhood groups to outline their research objectives, to provide assurance
concerning the quality of health care provided, to provide information on se-
curity arrangements and plans to deter loitering by clients, to gain the support
of key members of the community, and in general to guarantee that the treatment
facility would be a good neighbor in the community.

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