CLOSING A NEEDED CLINIC DOESN'T MAKE SENSE

Why do we tolerate the "war on drugs"? Why don't we fight addiction as
the disease that it is?

I've wondered that many times over years of writing pleading
editorials for more publicly funded substance abuse treatment. Never
did the question seem more urgent, though, than when I read in the
April 8 Current that the New River Valley Community Services Board in
Blacksburg will be shutting down Dr. Martha Wunsch's outpatient
addiction clinic June 30. And the reason? Resources, mainly.

"It's really, really unfortunate, because it's a wonderful service for
the community," she told me last week.

The publicly funded Community Services Board still will offer
substance abuse treatment, of course. But Wunsch, an addiction
medicine specialist, offers a treatment few other physicians are
qualified to provide. And through the public agency, she can offer it
at a price low-income patients can afford.

Wunsch is one of only two doctors in the New River Valley who can
prescribe Suboxone to opioid addicts who need the medication to stay
clean. Suboxone is itself an opioid that can free addicts of the
cravings that drive them to all kinds of antisocial behavior to get
their drug, and all kinds of bad behavior while they are high on it.
Properly prescribed and taken, Suboxone and methadone, another opioid
treatment, do not deliver that destructive high. Wunsch said the
Community Services Board is shutting down the clinic for lack of less
than $30,000 -- probably closer to $20,000, the amount it pays for her
to attend patients there one hour a week.

That's not the clinic's full expense, though, the board's executive
director, Lynn Chenault, explained in a phone interview. "It's very
resource-intensive," he said. "It's not just her time and her work.
People who have addictions tend to be very challenging and high
maintenance."

The agency knew this at the start. Substance abuse services are part
of its mission. But, he said, the clinic "is even more demanding on
our resources than we thought before we got into it."

It takes the work of nurses, case managers, counselors. And the
demands on the support staff grew and grew.

"It was getting bigger faster than we anticipated," Chenault said.
"She developed it faster and to a larger scale than we ever expected
it to be." And the clinic didn't find any new revenues to offset any
of the added costs. When a new medical director came on board in
January, he recommended phasing it out. The flip side of that coin,
however, is this: The high demand is evidence of a community need. And
the public agency's staff support is what has made the clinic
affordable for many people who need it.

"At the CSB, there's counselors, there's case managers," Wunsch
lamented, unknowingly echoing Chenault's concerns. "This agency is the
perfect place to provide these people with these services. ... From a
public health perspective, this clinic was brilliant."

Wunsch is working to establish a privately owned addiction treatment
clinic in Blacksburg, and she runs a small private practice in
addition to being an associate professor at the Edward Via Virginia
College of Osteopathic Medicine at Virginia Tech.

"In a private practice, I will find funding," she noted wryly. "It's
called, the patients will pay for it."

If they cannot, and public funding remains lacking, the community will
pay in worse ways: crime, for one, with its attendant costs for jails
and police, to say nothing of the losses to victims and the sense of
community well-being.

"In this area, given the [clinic] waiting list, we probably have at
least 1,000 people in need of services," Wunsch said.

Chenault agreed there is a huge and growing gap between need and
services, and that opioid treatment is one of the services needed. In
his 22 years as head of the NRV Community Services Board, he said,
there has been an "extreme, dramatically striking" change in the level
of public support. At the start of his tenure, the agency depended on
patient fees for 17 percent to 18 percent of its income. "Now that is
two-thirds." "This mandate of CSBs that we don't deny services to
people just because they can't pay -- that's harder and harder and
harder to do." Putting more and more people in prisons, though? That
is easy. So back to my question. Why do we, as a society, not spend
more on treatment? It's cheaper. And the savings include lives.