The budgetary crisis sweeping the states this year -- 43 will run budget deficits, according to the latest reports -- is hitting Massachusetts hard, and lawmakers have responded by, among other things, voting to cut all funding for the state's 40 methadone clinics. The clinics provide the opioid methadone as a treatment for heroin addiction, and also require participants to undergo mandatory weekly counseling and random drug tests. Public health officials, methadone advocates and even police officials are warning that shutting down the clinics will adversely affect both the public health and the crime rate.
With plenty of cheap, high purity heroin available and heroin use on the rise, according to public health officials, the cuts are particularly ill-timed. Dime bags of heroin now go for as little as $4, the Boston Globe reported this week -- about the price of a pack of cigarettes, the paper noted -- and the stuff is 80% pure, up from 15% a few years ago. Heroin users are filling 40% of state hospital drug treatment slots, running a close second to alcohol. In Boston alone, more than 10,000 residents were hospitalized last year for treatment for heroin addiction, said the Globe.
"The shift to heroin in recent years has been dramatic -- it's the highest it's ever been," James O'Connell, president of Healthcare for the Homeless told the Globe. "This is a huge public health problem, and methadone is the most effective way to treat it."
Nearly 11,000 people are currently enrolled in methadone programs in the state, said Tom Scott of the Massachusetts Department of Public Health's Division of Substance Abuse. More than three-quarters of those people would lose their slots in methadone maintenance programs, he told the Boston Herald.
"The human impact would be devastating," added John Auerbach, executive director of the Boston Public Health Commission.
"Elimination of the Massachusetts methadone maintenance programs would be nothing short of a public health disaster," said Mark W. Parrino, president of the American Association for the Treatment of Opioid Dependence (http://www.americanmethadone.org), an advocacy group representing more than nearly 700 treatment programs across the US. "The programs in Massachusetts have been in existence for more than two decades and are responsible for saving the lives of thousands of individuals," he told DRCNet. "It is inconceivable that the state legislature would put so many lives in jeopardy," he said.
But that's precisely what the Massachusetts House Ways and Means Committee did late in April as budget deficits spiraled out of control. As part of $1.5 billion in budget cuts distributed across state agencies, members voted to axe the $25 million appropriation that would have kept the clinics up and running. But if fiscal pressures spurred the lawmakers, several, including committee chair John Rogers (D-Norwood), revealed philosophical opposition to methadone maintenance in their comments, as well as crime concerns. "It's not that I don't feel for these people, but there are programs that are drug-free and that work better than just giving people another drug," Rep. Cheryl Rivers (D-Springfield), told the Globe. Rivers favored an abstinence-only approach to heroin addiction, calling for detox or other cold-turkey programs. She also complained that the two clinics in her district have created crime problems.
So did Chairman Rogers, who called the clinics "a nightmare" for their neighbors.
DRCNet could not obtain a breakdown of clinic-related crime, but in attempting to do so, did find an editorial from the New England Journal of Medicine last November. In a discussion of "new opportunities" in treating opiate dependence, the journal noted: "Methadone maintenance can decrease the use of illicit drugs and crime and help patients function better, gain employment, and contribute to society. It can also prevent health problems such as HIV infection and is thus a cost-effective public health intervention."
If the lawmakers don't get it, some police officials do. "When these people want these drugs, they're going to get it -- the addiction is that great," Lt. Frank Armstrong, commander of the Boston Police Drug Control Division, told the Globe. "What is the better good: that hundreds go to methadone clinics or that they're about town scurrying for more drugs?"
The state's budget battle is not yet over, and advocates vow to fight to restore the funding, but legislative opposition to maintaining addicts even on legal substitute opioids in a controlled setting combined with the suddenly shriveling state treasury may well doom the clinics.
But advocates are mobilizing for a last-ditch effort to save the clinics. "There has not yet been a final vote," said Parrino of the treatment association. "Our Massachusetts associates are working with other groups to have these funds restored," he told DRCNet. "I'm certain that the Massachusetts methadone maintenance providers and patient advocates will find a solution to this issue."
Only time will tell whether Parrino is whistling past the graveyard, so to speak.
Visit the National Alliance of Methadone Advocates at http://www.methadone.org for information on this issue from a patient/advocate perspective. Resource information is also available from Advocates for Recovery Through Medicine, http://members.aol.com/r2135/ online.