•    Develop a Plan for Drug Treatment on Demand

•    Allow Medicaid to Pay for Treatment for the Poor

•    Expand the Variety of Treatment Options Available

The drug czar should take a comprehensive assessment of drug treatment availability nationwide, then propose a target date and plan of attack for achieving treatment on demand everywhere in the United States. Governor Martinez should also work with Congress on legislation allowing Medicaid to cover drug treatment expenses for our nation's poor.

Martinez Treatment Record Lacking

Drug czar Martinez claims to have changed his stripes since his one term as governor of Florida, where he strongly emphasized law en-forcement and mass arrests to control drug abuse. Under his leadership, Florida lagged one-fifth behind the average state in per capita drug treat-ment funding and gave less than half what the average state gave to drug education and prevention. This poor record on treatment and education came despite Florida's desperate drug problem throughout the 1980s.

Mr. Martinez now admits the importance of drug treatment and has vowed to make it a focus of his tenure as drug czar. His commitment could not come at a more urgent time. Nationwide, waiting lists for treat-ment programs are months long. Recent figures from the NIDA Household Survey on Drug Abuse show a particularly acute need for treatment among hard-core drug-using populations in the inner cities. Too many Americans seeking help for their drug problems are finding it unavailable or finding they cannot afford it.

Make Treatment on Demand a Real Administration Commitment

Nineteen ninety-two must be the year that "drug treatment on demand" is transformed from a mere slogan to a comprehensive program.

To this end, drug czar Martinez should order his office to undertake an assessment of drug treatment availability and needs state-by-state, then work with Congress to develop a plan to achieve treatment on demand by an agreed-upon target date. Failure of the Office of National Drug Control Policy to take the lead on such an initiative will indicate a purely rhetori-cal commitment to providing urgently needed drug treatment services.

Part of any plan to provide drug treatment more widely must be a commitment to diversity in treatment methods and funding options. The plan should include easier access to methadone programs, religious and non-religious-based treatment and research on new treatment methods, including other maintenance drugs. In light of evidence suggesting a resurgence in heroin imports and usage, we must learn from our national experience with heroin outbreaks in the 1960s and 1970s. Methadone programs are one of the effective legacies of that experience, and they must be strengthened in preparation for the new heroin surge.

Treatment should be non-coercive and user-friendly, not a new form of punishment. Coercive treatment is particularly inappropriate when people are waiting for treatment slots. In this regard we are espe-cially concerned about children abused in drug treatment programs. President Bush should rescind his endorsement of Straight, Inc., the confrontational youth treatment center found guilty of abuses and rights violations. Reports of abuse continue to flow out of its centers across the country.

Whether a program is federally sponsored, state-sponsored, a partnership or a private program, adequate funding should be made available by state and federal authorities, subject to appropriate condi-tions. This approach is the quickest way to expand treatment availability without incurring great construction and startup costs, while helping the private treatment business flourish.

President Should Tell HCFA to Arrange Medicaid Coverage of Treatment

Members of Congress and the General Accounting Office have recently pointed out the great opportunities lost because Medicaid does not cover most drug treatment services in most states. Our nation's poor, the population which can least afford treatment and which contains many of the hardest-to-reach drug abusers, would be the immediate winners if the federal Medicaid guidelines were-changed. The president and director Martinez should work with the Health Care Financing Administration and Congress now to develop a policy on the use of Medicaid funds for sub-stance abuse treatment, especially for pregnant women. This work will also serve as a model for state health services departments to expand treatment availability.