Appendix

Harris County, Texas

A Centers for Disease Control (CDC) investigation was prompted by events in Harris County, Texas. In 1991, a reported rise in the number of methadone-related deaths in Harris County led to increased scrutiny by authorities over local methadone treatment programs. Most methadone treatment programs in Houston and the surrounding areas are private, and for-profit, having been developed to fill the void left when local government abandoned the service delivery of methadone treatment. Federal regulators began investigating the claim that methadone-related deaths were occurring from illicit methadone originating from poorly monitored methadone treatment programs. Liberal methadone take-home policies were blamed for creating a situation where addicts could sell their surplus methadone on the black market. These problems prompted a six-month joint investigation by DEA, FDA, and the Texas Department of Health.

In March 1992, acting on the basis of an undercover purchase of illicit methadone, DEA ordered a privately owned, for-profit methadone clinic in Houston to show cause why its license to dispense methadone should not be suspended. The clinic was closed and this closure was soon followed by similar orders to close two more clinics—all three owned by the same person. DEA orders to close these three clinics were described in a series of articles by the Houston Chronicle (e.g., "Methadone Clinic Shut in Raid Here," March 19, 1992, and "2d Methadone Facility Shuts Down," April 10, 1992), which were distributed over the national wire services and publicized widely. The articles also reported, quite inaccurately, that methadone was killing nearly twice as many people in the Houston area as was heroin, which was attributed to poorly run methadone clinics.

In November 1992, prompted by reports of an increase in the number of methadone-related deaths in Harris County in 1991, the Texas Department of Health and the Interagency Methadone Policy Review Board, a committee composed of representatives from all federal agencies involved in oversight of methadone treatment, invited the CDC to investigate the deaths in Harris County. The CDC investigation was the most careful and comprehensive of recent investigations into methadone-related deaths.

The incidents in Texas (but not including the CDC investigation, which was then in progress) received nationwide television attention on February 21, 1993, when CBS News, on "60 Minutes," broadcast a segment entitled "Just Say Yes." In this segment, "60 Minutes" focused on DEA-enforced closures of the three Houston methadone maintenance clinics and stressed the public and political opposition to methadone maintenance treatment. The ''60 Minute''



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