METHADONE'S BIG GULP

State Lawmakers Quietly Gut Drug Treatment And Mental Health.

Thousands of heroin addicts who have kicked the habit with the help of
methadone will be squeezing the last precious drops of orange juice from
their paper cups next year, thanks to drastic but little-noticed cuts in the
Oregon Health Plan.

The budget cuts, quietly imposed by a panel of state lawmakers last month,
will boot about 1,850 clients (of 3,775 statewide) out of methadone
programs.

"It'll have a devastating effect," says Tim Hartnett, executive director of
CODA, which treats 900 clients in Portland and Eugene, providing them highly
regulated daily doses of substitute narcotic that doesn't get them high.
"This is like withholding insulin from diabetics."

Methadone treatment is typically reserved for chronic, hardcore junkies who
have tried--over and over--to stay clean by conventional means.

Take Jim G., 52, a hard-bitten recovering heroin addict and former tugboat
captain. By his own count, Jim tried to kick junk hundreds of times before
he joined the methadone program. "It's made a big difference in my life,"
says Jim, standing outside the Delta Clinic on Southeast Belmont Street on a
chilly Monday morning. "It's been a tough road, and methadone has helped
me."

Providers are now wrestling with a diabolical paradox: how to taper down
clients without pushing them back to heroin.

Most experts agree this is a long shot. "This is a set-up to relapse," says
Pat Gold, program manager at Delta. "We're going to lose some people back to
the streets. That's just the reality."

Designed as a long-term therapy, methadone is actually harder to detoxify
from than heroin. Typical doses range from 60 to 100 milligrams a day. Some
addicts take 200 milligrams a day--a lethal dose for a civilian.

For clients, the prospect of losing their methadone is terrifying. "I'm
scared to death," says Donna, 31, a recovering heroin addict who has been on
methadone for two years. "People are panicking."

Some methadone clients say they are ready to get off the drug. Others hope
to find some way to pay for their treatment, which costs approximately $250
a month. But there is little doubt that hundreds will succumb to their
addiction.

"People should be very concerned about the public-safety implications of all
this," says Multnomah County Chair Diane Linn.

But methadone is only the tip of the iceberg. Starting March 1, the standard
package of the Oregon Health Plan will no longer cover any
chemical-dependency, mental-health or dental services for approximately
100,000 low-income Oregonians.

Altogether, lawmakers cut $18 million worth of services. But these cuts will
produce just $7 million of savings to the state's general fund, because the
state health plan gets roughly 60 percent of its money from federal matching
funds.

The decision sparked fury among treatment providers and advocates for the
mentally ill, in part because the cuts were imposed without any public
testimony.

The state Department of Human Services originally proposed that the Oregon
Health Plan reduce its reimbursement rates to hospitals, which are currently
paid 74 percent of their costs. But the hospitals successfully lobbied
lawmakers, who decided to ax services instead.

"The best way to put this is that hospitals went to [lawmakers] and made the
case that their needs were greater than the needs of the people on the
Oregon Health Plan," says Tom Towslee, spokesman for Gov. John Kitzhaber.
"Unfortunately, the people who would be affected never got a chance to make
their case."

The pain will be multiplied if Measure 28's income-tax increase fails in
January, which would force much deeper cuts. Worse, Multnomah County, which
funds many treatment services, is also facing a deficit of $20 million. "The
timing is breathtaking," says Linn.

Social-service advocates predict the lawmakers' action won't save any money.
Without access to psychiatric medication or therapists, patients with mental
illness tend to destabilize and show up in ERs or jails. Addicts who can't
get treatment can't get clean, and they may have the same destinations.

"Alcohol and drug abuse has an extraordinary effect on so many other
concerns," says CODA's Hartnett. "Look at any issue people are concerned
about. Crime. Domestic violence. Child abuse. Teenage pregnancy. Traffic
fatalities. Unemployment. Did I mention divorce? Alcohol and drug abuse is
the root cause or a substantially contributing factor in all those issues."

Outside the Delta Clinic, a throng of clients descended on a reporter to
offer views about the budget cuts.

"There's gonna be so many sick people," said one.

"I don't know what I'm going to do if they cut it off," said another.

"They better hire a lot more security guards!" said a third.

Meanwhile, Portland treatment providers are bracing for the March 1
deadline, when thousands of addicts will no longer be able to get into
treatment.

"I can't imagine what our possible response would be," says Sgt. Brian
Schmautz, Portland Police Bureau spokesman. "All we can do is respond to
calls and do our best."