MEDI-CAL CUTS ARE SHORTSIGHTED: METHADONE TREATMENT PAYS OFF

Gov. Arnold Schwarzenegger's budget proposes cutting Medi-Cal funding
for methadone maintenance. The $53 million that would ostensibly be
saved would, in fact, cost Californians a lot more.

To begin, the state would lose more than $60 million in federal
support for methadone treatment programs as a result of the state not
making the investments required to qualify for federal funds.

This budget cut would also generate enormous socio-economic costs. A
National Institute on Drug Abuse (NIDA) study found, for example,
that methadone treatment reduced participants' heroin use by 70
percent and their criminal activity by 57 percent, and increased
their full-time employment by 24 percent. The annual cost of
methadone therapy about $5,000 per patient is a fraction of the
cost of jailing a heroin abuser or of the lifetime health costs of
treating the illnesses that are frequently caught by injecting drug users.

A 1995 Institute of Medicine report concluded that "methadone
maintenance pays for itself on the day it is delivered, and
post-treatment effects are an economic bonus." Another study
estimated that every dollar spent on methadone maintenance treatment
results in $4 of economic benefit as a result of patients' reduced
criminal behavior and increased health.

A 1997 National Institutes of Health report estimated the financial
costs of untreated opiate addiction at $20 billion per year. More
treatment can significantly reduce these costs. Cutting funding for
methadone is clearly bad public policy and a terrible economic decision.

Cutting funding for methadone ignores hundreds of scientific studies
and 40 years of clinical experience. It has been proven to be safe
and does not impair mental capability, motor function or
employability. It is not toxic to the body or vital organs. Patients
can drive vehicles and operate machinery safely while using the drug.
What it can do is allow individuals to become free of heroin
addiction. In fact, no other treatment modality is as effective in
achieving this goal.

Unfortunately, only 20 percent of the 1 million-plus heroin and
opiate addicts in the United States and California receive methadone
maintenance treatment. These individuals risk premature death and
often suffer from HIV, hepatitis, sexually transmitted disease
(STDs), liver disease from alcohol abuse, and other physical and
mental health problems.

Five thousand to 10,000 opiate addicts die of drug overdoses every
year. Many are involved with the criminal justice system. Instead of
cutting support of methadone treatment programs, the state should expand it.

The proposed budget cut betrays a common bias against narcotic
replacement therapies. Many criticize methadone because it does not
result in "drug-free" individuals. This is because chronic use of
opiates can result in abnormalities of brain physiologic functioning
that persist for years after detoxification and are associated with
the extremely high relapse rate associated with other forms of treatment.

Opiate addiction is a biomedical condition, not a personal flaw or
choice. In fact, methadone, combined with counseling and proper
medical and psychiatric care, is often essential to enable addicted
individuals to cease use of illegal opiates. Seeking to address it
via incarceration, detoxification and drug-free modalities won't work.

As a matter of medicine, science, public health, compassion and
fiscal policy, methadone treatment must be a medical option for all
heroin-dependent persons in California who could benefit from such
treatment. Policies and budgets that would restrict access to
methadone treatment fly in the face of science and economic common sense.

As legislators consider proposed cuts to methadone treatment
programs, they would do well to study the science of opiate
addiction, the proven effectiveness of this critical treatment
modality, and the demonstrated cost savings it provides to society.