BUDGET CUTS PUT FEDERAL DRUG ABUSE AID AT RISK

With New England in the midst of an epidemic of heroin use,
Massachusetts is on the verge of forfeiting more than $9 million in
federal aid for treating drug users, a penalty for three years of
reductions in state spending on substance abuse services.

Since the 2001 budget year, the state Department of Public Health has
cut nearly $11 million from what it devotes to treating drug users and
preventing narcotic and alcohol abuse. Governor Mitt Romney is
proposing $2 million in additional reductions for the next budget
year, although a representative of the governor said those cuts would
not imperil essential services.

Executives who run treatment centers and health care advocates said
that the Department of Public Health cuts in combination with
reductions in other state programs, particularly the MassHealth Basic
insurance plan for the poor, have already spawned deep reductions in
services.

Among the most graphic examples: The number of treatment beds
dedicated to substance users needing urgent detoxification has
plummeted from nearly 1,000 statewide a year ago to just 420 now,
meaning patients wait weeks or even months for a slot.

States that receive grants from the US Substance Abuse and Mental
Health Services Administration pledge to maintain fairly constant
levels of financial support for substance abuse programs. Because
Massachusetts has not, the federal agency notified the state late last
year that it is in violation of the grant program's rules and that,
under a complex formula, it will lose $9.2 million from the $34.3
million it was poised to receive for the coming budget year.

The consequences of such a loss -- which would amount to 13 percent of
the total substance abuse budget in the Department of Public Health --
would prove devastating, treatment center executives warn. It would
occur as the region struggles with an unparalleled surge in heroin use
and deaths related to that drug and other opioids, including the
prescription painkiller OxyContin.

Accidental overdose deaths of Massachusetts residents attributed to
opioid use soared from 94 in 1990 to 487 in 2001, the latest year for
which figures are available from the department.

"The potential loss of another $9 million in substance abuse funding
would be disastrous to the Commonwealth," said John Auerbach,
executive director of the Boston Public Health Commission. "Our
treatment and prevention efforts have already been significantly
crippled and the prospect of facing millions of dollars of additional
cuts would bring our substance abuse system to its knees."

Federal authorities, who last month denied an appeal from the state,
acknowledge that the reduction would harm users desperate for help.
But in both a letter to the state that was obtained by the Globe and
in an interview, representatives from the substance abuse agency said
they had little choice.

"As much as it may pain us to do this, it's the law, and we'll be
carrying it out," said Mark Weber, spokesman for the federal agency.

State public health authorities are making a last-ditch appeal to
their federal counterparts, Department of Public Health spokeswoman
Roseanne Pawelec said. "The governor is relying on us to make the
state's case that we've done a good job of maintaining core services
and maintaining access to services despite a budget situation that
mandated reductions," she said.

Pawelec said Romney remains urgently concerned about rampant use of
heroin and has directed Public Health Commissioner Christine C.
Ferguson to review substance abuse services provided by state agencies.

Bonita Richardson is the face of the region's heroin crisis -- and an
example of what happens when services have to be cut. Heroin has
defined Richardson's life for more than two decades, beginning before
she was old enough to drink and stretching into the start of middle
age. Finally, she said, at the age of 42, "I'm sick and tired of using
drugs. It's just that simple. I'm at the end of my innocence."

So, early in March, Richardson contacted Community Healthlink, which
provides substance abuse and mental health treatment in the central
part of the state. But for nearly three weeks, the Worcester agency
had no space, forcing Richardson to wait.

"I kept calling for a bed, and I kept using drugs," said Richardson,
who began receiving treatment last Wednesday. "Every day, I was strung
out on drugs. I used as much as I could. If people want to get help
and they can't get it, they're just going to do more destructive
things to get their drugs."

The effects of delaying treatment, substance abuse specialists said,
ripple far beyond the users.

"It creates a lot of human misery for those patients, but also a lot
of attendant pain and cost for society," said Deborah Ekstrom,
president of Community Healthlink. "If those patients are really in a
medical emergency, they go to the hospital emergency rooms where they
take up attention and medical resources that would otherwise be
devoted to other people. So if you go in there with a broken arm, you
wait longer."

State Representative Peter Larkin, assistant vice chairman of the
House Ways and Means Committee, expressed little optimism about being
able to find additional state dollars for substance abuse services.
Lagging economic conditions in recent years left legislators with
little room to navigate as tax revenues dropped, said Larkin, a
Democrat from Pittsfield.

Federal authorities, he said, should recognize the financial distress
of states such as Massachusetts and not impose even more hardship by
reducing grants.

That's what happened last year, when the federal government did issue
a waiver to Massachusetts, accepting the economic hardship argument.
But this year, that position has already been rejected, with a letter
from an agency executive stating that the state failed to prove it was
beset by "extraordinary economic conditions" that warranted an exemption.

Another House member, Dorchester Democrat Martin J. Walsh, said he
believes that if his colleagues move swiftly, they might succeed in
changing the minds of federal authorities. Walsh has proposed
restoring $4.5 million from what has been excised from the state's
Bureau of Substance Abuse Services in the hope that federal
authorities will see that as a good-faith gesture and not reduce the
grant.

Walsh has sent a letter supported by about 30 legislators to the House
Ways and Means Committee asking for the additional dollars.

"It's absurd that we are leaving $9 million on the table when we have
people dying every single day," Walsh said. "I'll tell you right now,
if we as a Legislature don't restore some of these funds, more people
are going to die, and it's going to be our responsibility if these
people die."