Methadone clinics feeling pain of state budget cuts

Gabor Degre, Bangor Daily News

Jessica Payne, 34, of Bangor has been off drugs and taking methadone for three years. Payne believes that the availability of the methadone treatment and the support has been key to her recovery. "I have needed all three years of treatment and would probably need one more. Cutting the funding would hurt people who are entering treatment now," she said.

Jessica Payne got hooked on drugs at just 16 years old. A prescription for Percocet to treat her chronic pain and a birth defect in her hands opened the door to what would stretch into more than a decade of addiction.

“I would do whatever was put in front of me, whether it was uppers, downers, it didn’t matter,” Payne said. “But OxyContin was my drug of choice.”

Years of intravenous drug use, including heroin, led to a stint in state prison for drug dealing. Payne lost custody of her son. But it wasn’t until her father, who was largely absent during her childhood, died from an overdose of crystal methamphetamine that Payne decided to try methadone treatment.

“It was one of those moments where I realized that if I didn’t change my life I was going to die like him, and it was going to be my son feeling this guilt and wondering why,” she said.

Payne, 34, finally sought help three years ago from the Discovery House methadone clinic in Bangor. She now has been clean for two years and leads a peer support group for methadone patients and others.

Payne, who lives in Bangor, has no doubt she would be dead today were it not for the methadone, a synthetic opiate, and support from her peers and counselors.

“I’ve just been building my life back up,” she said. “I talk to my son now and I have friends who don’t use drugs and I go see blues music and I have a life.”

The Discovery House clinic in Bangor is one of nine methadone clinics in Maine reeling from a state budget cut that some say puts their survival at risk. The cut, which slashes Medicaid reimbursements, has led the state to consider temporarily easing regulations on methadone treatment so clinics can stay in compliance.

As of April 1, Maine’s methadone clinics are receiving $60 per week for each Medicaid patient they treat. That’s down from $70 over the previous year and a half and a steep drop from the $80 reimbursement of the prior decade.

With costs averaging $115 per person each week, clinics have long offered more services than Medicaid has paid them for, according to Dr. Joseph Py, corporate medical director for Discovery House, which has clinics in Bangor, South Portland, Calais and Waterville.

The reduction to $60 per patient per week makes Maine’s Medicaid reimbursement the lowest in the country, he said. Meanwhile, paperwork and counseling requirements have increased, Py said.

“This makes it extremely difficult for us to try and figure out if we can survive,” he said. “We’re not sure at this point how we’re going to do that.”

The reimbursement covers methadone dosing, medical checks, drug screening and counseling.

Roughly 85 percent of all methadone patients in Maine are covered by or eligible for Medicaid, known in the state as MaineCare. That leaves clinics little room to cover their losses by shifting costs to patients with private insurance.

The cut comes as the state Legislature struggles to balance the budget for health and social services. Maine spent $3.6 million in fiscal year 2010 on methadone treatment for 3,500 MaineCare patients, with the federal government kicking in another $6.2 million.

An additional $7 million in state dollars paid for recipients’ transportation to methadone clinics and service sites.

In response to clinics’ financial concerns about the reimbursement rollback, the state is moving toward temporarily relaxing regulations over staffing ratios for methadone clinics. The Department of Health and Human Services’ Office of Substance Abuse has suggested that through June 30, clinics could assign one counselor for every 150 patients.

Licensing regulations call for a ratio of one staffer to every 50 patients.

“It’s an effort to maintain that service at a level that we’re comfortable with,” said Guy Cousins, director of the Office of Substance Abuse. Methadone treatment practices are based on research and clinical expertise, which the state must balance against budget realities, he said.

The 2010 reimbursement cut, to $70 per patient per week plus a $2 co-pay, also resulted in an exemption for some clinics, he said.

It’s not uncommon for the state Office of Substance Abuse to issue waivers, but the staffing ratio proposed in the most recent exemption is unprecedented, Py said.

As a result of the reimbursement cut, clinics have been forced to cut back on counseling services, an integral part of successful methadone treatment, according to Jennifer Minthorn, assistant vice president of development and community relations for Merrimack River Medical Services, which operates the Portland and Lewiston methadone clinics.

“If we do not provide the level of counseling that’s required by our accreditation company, we could lose our accreditation and go out of business,” she said.

Decades of research show that methadone treatment works and is cost-effective, Minthorn said.

“These folks really want to make improvements in their lives, and the research has really shown that it does [work] and we’ve seen firsthand the improvements people make,” she said. “They hit bottom and they’re able to reconnect with their families, they’re able to go back to school, they’re able to get jobs.”

If patients in Maine can’t get treatment, the costs will shift to jails, as addicts steal to get drugs, as well as to emergency rooms, where drug users attempt to score painkillers or wind up after an overdose, she said.

The reimbursement cut is projected to save about $87,000 in this fiscal year, plus $475,000 next year. Those savings are minuscule in light of the public health crisis the cuts would cause in the long term, Py said.

According to a 2011 federal report, Maine tops the nation in the number of residents seeking treatment for prescription drug abuse.

Py said the Office of Substance Abuse is working with clinics to cope with the reimbursement cut.

Clinics also are facing another piece of legislation that would require special authorization for MaineCare patients to continue methadone treatment beyond two years. LD 1840, which lawmakers passed pending final approval of the Legislature’s budget-writing committee, requires providers to get state preapproval for a longer treatment period.

Rep. David Burns, R-Whiting, the bill’s sponsor, said two years of methadone treatment is long enough to determine whether a patient has a medical need to continue.

“Under the current system, addicts can receive methadone for years — it’s open-ended,” he said in a March press release. “This is expensive treatment, and since the taxpayers are paying the bill it’s only fair that we put some oversight in place.”

Burns’ bill is projected to save about $1.5 million in state money in the next fiscal year, and nearly $3 million over each of the following two years.

Minthorn argued that methadone treatment is too individualized to set time limits on patients.

“People come into treatment at different stages of their dependency,” she said. “Some people might have been addicted to opiates for 20 years, versus someone that might have been addicted for only a couple of years.”

Jessica Payne said she’s tapering down her dose of the medication. But she’s not ready to cut off treatment just yet, she said.

“I’ve been on it three solid years and I’m just now at a point where I feel I can live a life without methadone,” Payne said.

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Comments

Richard Begin's picture

Methadone Sob Story

Scott;
Well said. I would agree with your observation that the Maiden in this Story has more than likely never has a License Never had employment, Never Had Respondsibility, Never had a clue.

Now Unfortunately but true this Article has provided her with her very Own 15 Minutes of Fame.

I would have enjoyed being a Fly on the Wall as she and her fellow Dependents gathered round the Coffee counter and shared stories about their own Battles with the Demon on their Shoulder.

Now in her own Happy World she has gained Celebrity Status,I Bet she is a Cigerette Smoker, Probally a Dedicataed Mountain Dew Drinker,

She has more than Likely subjected her Outer Body to the Mindless expressions of Body ink.

More than likely she spent Voluminous hours after the story came out on Facebook texting all of her fellow Addicts.

I believe that She and other like her should be presented with a Binding Contract that demands that she Ante up with the State of Maine to pay for her own treatment.

However the Sneaky But Crafty Democrats be assurred will come to her Aid, as like the Same Sex Forces they understand that they have a willing and desperately Waiting Voter Bloc to work with.

How can one ignore such an opportunity ?.

GARY SAVARD's picture

This is just another spoke in

This is just another spoke in the wheels of the welfare wagon that year after year gains happy passengers while the number of people doing the pulling slowly dwindles. No wonder government at all levels is cash starved and constantly looking to dig deeper into the
pockets of the few that are feeding this monster.

Jillian Campbell's picture

curious

I wonder what the cost difference is between funding the drug treatment program (per individual) per year versus the cost to have someone in jail for a year.

There is only so long you can get away with doing something before you get caught. These people will eventually end up in jail if left untreated. Whether they get arrested for possession, dealing, violence or theft... it is going to cost tax dollars one way or the other. Just look at the story posted on www.dailybulldog.com today. Those guys that robbed the elderly couple on halloween (for painkillers and drug money) are looking at at least 15 years each. That is a lot of tax dollars for sure.

Richard Begin's picture

Methadone Sob Story

Imagine Young Jessica what a Future her Actions and behjavior created.?

Now the Taxpayers of Maine have to Ante up to pay for her over Indulgences. What a Deal Only in the Current America.

Fortunately Governor Lepage has seen the Value and better yet common sense to examine this Scam of Funding these rejects .Also to add insult an Injury to the Readers and Ultimately the Tax Payers 'Our Jesica needs just one more year to complete her treatment.

How about that. Wow She is one bright looking item in that Picture.

So Serenely Happy looking .

However consider this Community Concepts in Lewiston and Auburn and South Paris have a Cottage industry where those or a Major Portion of those getting the Methadone daily treatments need to get to the appointments.

So Driver after Driver will deliver these Indigents to and from their daily appointment. Not a bad deal for the User,

although many Older drivers flat out refuse to truck these folks because they grew up in the Real America, An America where People worked for what they got and in that Same America a 'Man Married a Woman'

Also in that Pre Nafta America( Thanks Bill Clinton and Al Gore) younger folks had jobs working in industrys that had sustained Generations for Life times.Of course the Corporate greed that was encouraged to run amok and the Pay off for them would be NAFTA what a deal.

No Jobs there is the EBT Card and Wholesale Welfare programs 'Cradle to Grave' Thanks Mr & Mrs Democrat and Mr & Mrs Republican.

So The Tax payer Pays and pays and if we were to suspend the Methdone program then many Driver who work for Community Concepts would be out of work.

The Drivers get paid 41 Cents per mile thusly they are not required to pay taxes on that income because their status is listed as Volunteer.
It's a Fuuny Deal?

 's picture

The Biggest Abused Program In Maine Is Methadone

This program has cost Maine taxpayers more money than even thought of when this farce of a program started.

If a person can't clean up after six months of taking this crap it clearly shows that all methadone is is a just a replacement for the drugs people were taking before.

These so called "clinics" are just a money making machine at the expense of every hard working Mainer.

My guess is that there are some lobbyist hard at work to ensure the pockets of the clinics owners stay lined.

 's picture

tired of paying

I think the people of Maine are just tired of paying for welfare in general. What used to be seen as helping those less fortunate 25 years ago has turned into too many people making poor lifestyle choices and looking for someone to help them out. Look at Jessica in this article. I do not know Jessica at all and I congratulate her of getting her life back together. But, I have to assume that most of the last 15 years of her life were spent on food stamps, welfare, unemployment, maybe even telling little white lies to keep getting assistance. How much has this one person cost the state? As a democrat, I applaud Governor LePage for looking to trim the huge welfare and associated budgets. These handouts become never ending.

 's picture

State Paying For Clinics

Why should the State be paying for people to get off these drugs? It is not the states fault these people are on drugs. Therefor the state should not be using hard workers money and tax payer monies to get these people off drugs. Let them get a supportive paying job and pay for their own rehab. Thats why most states don't have enough money.

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