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I-Team Special Report: Detox Dilemma

Updated: Wednesday, February 26, 2014 |
I-Team Special Report: Detox Dilemma story image
KALAMAZOO, Mich. (NEWSCHANNEL 3) - It's a decades old method for treating drug addiction, but now more people than ever before in Michigan are using methadone therapy.

The drug is an addictive painkiller, and the Newschannel 3 I-Team found the government is paying millions to give it out, with some people taking it for free for years.

There are six methadone treatment facilities across Michigan, with one in Kalamazoo.

They are for-profit businesses, and making money because while other things are being cut in Michigan, money for methadone therapy for drug addiction keeps increasing.

Every morning before dawn, they pull into the parking lot and line up outside the clinic.

For thousands of people across Michigan, the day starts with methadone treatments. A small dose of liquid methadone before heading off to work or school.

And there are usually big crowds outside the clinic.

"Like I said, it was like five years ago when I came, and they were in the building over there," one man said. "There were nowhere near this many people."

The man is just beginning a new treatment schedule at Victory Clinical Services, in Kalamazoo.

It's all paid for by Medicaid, and he says he can continue in the program as long as it takes to overcome his heroin addiction. Some of his friends have been coming for years.

"Some people just do it, and they just stay here and they never, I don't think it should be done like that," he said.

"There's some people that have been going ten, 15 years," he added.

Methadone is usually used to treat heroin addiction, and is itself an addictive drug, but it is slow-release.

The strategy of the government and providers is that at least on methadone instead of heroin, people can still function and have jobs.

But with the government paying for it, there's no incentive to stop taking it.

"Fortunately or unfortunately, substance abuse treatment is now a business," said Dennis Simpson, with the WMU Alcohol and Drug Abuse Program.

Simpson points out that companies that distribute the treatments are for-profit businesses, and need customers.

"If you see people that are heads of agencies they are less therapists many times and more business administrators, so they look at the bottom line," he said. "When you get into for-profit entities, you have an obligation and responsibility to your stock holders to produce a profit, which means you have to have a number of people in there."

The Michigan Department of Community Health tells us people can receive the treatments for two years for free. After that, they can continue indefinitely if they prove a medical need.

The I-Team dug into the numbers and found in the last three years, the number of people getting methadone has increased, as has the amount of money the state spends on treatments.

$6.5 million in 2010, $6.8 million in 2011, and $8.3 million in 2012.

This has been happening at a time when other programs in Michigan were being cut.

For example, unemployment benefits were reduced from 26 to 20 weeks in 2012.

Higher education funding was reduced by $225 million. But methadone spending went up $1.5 million.

But the state feels the treatments are effective for some people. A Department of Community Health spokesperson told us:

"The Michigan Department of Community Health certainly sees value in supporting the substance use programs across the state, especially given the increase we're seeing in the abuse of different drugs. MDCH is continually working with our partners to find new ways to address substance use issues as they arise as well as continuing the funding of effective programs."

But people like Dr. Simpson who study rehabilitation say not everyone getting methadone truly needs to have it--or to get it for free.

Victory Clinical Services referred our questions to a spokesperson for the National Association of Opioid Dependence, who issued the following statement:

"The bottom line is that providing access to such treatment saves society an enormous amount of money. Important factors to take into account include emergency room admissions, criminal justice related issues including costs of police and courts.

"Some may need to use this medication for their natural lifetime, just as hypertensives and diabetics would remain on their medications."

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The entire statement can be found below:

With regard to the effectiveness of methadone maintenance treatment, it is one of the most researched medications for the treatment of any chronic disease in the world. Most of the methadone related research has been funded by the National Institute on Drug Abuse, which is part of the National Institutes of Health. The efficacy of treatment is certainly referenced in the NIDA publication “Principles of Drug Addiction Treatment”, which was published in a Second Edition in 2009. It provides an important point about the use of Medication Assisted Treatment for opioid addiction. Medication Assisted Treatment includes methadone, buprenorphine, and the more recently approved Naltrexone/Vivitrol. The NIDA publication, as referenced above, clearly indicates that “to be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.” Ultimately, effective treatment goes beyond the prescribing of any of the federally approved medications. I encourage you to access this document through NIDA’s website.

It is also important to reference the Treatment Improvement Protocol, which was published through the Substance Abuse and Mental Health Services Administration, which is part of the Department of Health and Human Services. The publication is titled “Medication Assisted Treatment for Opioid Addiction in Opioid Treatment Programs” and was published in 2005. It still represents the most comprehensive resource for clinicians who use medications to treat chronic opioid addiction. “The medical community recognizes that opioid addiction is a chronic medical disorder that can be treated effectively with a combination of medication and psychosocial services. I would also encourage you to reference this comprehensive document as well, which provides extremely detailed information through SAMHSA’s website (TIP #43).

With regard to the value of investing in such treatment interventions by state and federal governments, one of the landmark studies was performed in California by Dean Gersten (CALDATA). It demonstrated the tremendous return for interventions such as methadone maintenance treatment. Another NIDA funded study (Treatment Outcome Perspective Study: TOPS) analyzed the average cost of treatment and cost to society in addition to economic benefits and costs of treatment. Dr. Rick Harwood published this study and found that every dollar invested in treatment would produce a $4.00 return in recovered social costs. Other studies have put this ratio higher at a $7.00 savings when broader medical treatment issues and criminal justice issues are taken into account. The bottom line is that providing access to such treatment saves society an enormous amount of money. Important factors to take into account include emergency room admissions, criminal justice related issues including costs of police and courts.

With regard to people truly needing access to such medication, most patients who are admitted to treatment have been using opioids for many years. Based on research studies, the clear majority of such patients have tried and failed at short term detoxification attempts or residential care. Chronic opioid addiction is known to be a chronic relapsing disorder and this is discussed in an article that Dr. Alan Leshner wrote some years ago, “Addiction is a Brain Disease”. I am attaching it for your review.

With regard to your final question, we have learned after many years of clinical practice and research, that a significant majority of the patients (75%) will need to use this medication for long periods of time. Some may need to use this medication for their natural lifetime, just as hypertensives and diabetics would remain on their medications. There really is little difference with regard to the use of medications to treat a disease which is chronic in nature. The sources that I have referenced through the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration will clearly support this perspective.

Finally, it is important to keep in mind the shame and stigma which is associated with opioid addiction and its treatment. I am attaching an article which was written by Drs. Magura and Rosenblum about the lessons learned and forgotten about treatment. The article provides an excellent summary of the many studies that have been done with regard to patient relapse as treatment is discontinued. Policymakers are advised to be extremely careful about setting up artificial barriers with regard to the length of time a patient may remain in treatment.
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Business News

Last Update on July 30, 2015 17:30 GMT

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WASHINGTON (AP) -- More people sought U.S. unemployment benefits last week, though the increase was from a very low level and the figures still point to a healthy job market.

The Labor Department says applications for jobless aid rose 12,000 to a seasonally adjusted 267,000. The four-week average, a less volatile measure, dropped 3,750 to 274,750.

Applications are a proxy for layoffs, and two weeks ago they plummeted to the lowest level in almost 42 years. That suggests that Americans are enjoying a nearly unprecedented level of job security.

The number of people receiving benefits rose 46,000 to 2.26 million. That figure has fallen 11.2 percent in the past year as employers have stepped up hiring, though some of that decline reflects those who have exhausted all the benefits available to them.

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WASHINGTON (AP) -- After a harsh winter, the U.S. economy posted a solid rebound in the April-June quarter, led by a surge in consumer spending and a recovery in foreign trade.

The Commerce Department says the gross domestic product, the economy's total output of goods and services, expanded at a 2.3 percent annual rate in the second quarter, up from a 0.6 percent first quarter increase. The first quarter figure was revised from a previous estimate of a 0.2 percent decline.

The healthy spring rebound reflected a big jump in consumer spending and a swing in trade from a significant drag to a small positive for growth.

Economists are looking for growth to strengthen more in the second half of this year, as consumer spending is bolstered by sizable employment gains.

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WASHINGTON (AP) -- The U.S. economy grew more slowly over the past three years than the government had previously estimated, held back by more frugal consumers and steeper spending cuts by state and local governments.

The Commerce Department says the economy expanded at just a 2 percent annual rate from 2012 through 2014, down from a previous estimate of 2.3 percent. Nearly all the weaker-than-expected growth occurred in 2013, when the government now says the economy expanded just 1.5 percent, much less than its previous 2.2 percent estimate.

The revisions show that the economy's already-modest growth since 2011 was even weaker than thought. The recovery since the Great Recession officially ended in June 2009 has been the slowest of any since World War II.

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The Senate turned after the vote to a House bill that extends the government's authority to process aid payments through Oct. 29. Without action, that authority expires at midnight Friday. House Republican leaders opted for the patch to give themselves more time to work on a long-term bill.

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The inspector general of the Health and Human Services Department finds that only one out of 23 co-ops -- the one in Maine -- made money last year.

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The Justice Department says that the justices should reverse the December ruling by the 2nd U.S. Circuit Court of Appeals in New York and reinstate the convictions of Anthony Chiasson of New York and Todd Newman of Massachusetts.

The appellate judges said the defendants were too far removed from inside information to be prosecuted and more generally criticized criminal cases that resulted in over 80 insider trading convictions since 2008.

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Fiat said Thursday that net profit was 333 million euros ($364 million), compared with 197 million euros in the same period last year. The carmaker said it was raising its revenue forecast to 110 billion euros from 108 billion euros, on worldwide shipments of 4.8 million units.

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The recall covers certain 15- and 16-inch Hercules Tire & Rubber Co. All Trac A/T tires made from June of 2008 to May of 2010.

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It was unclear if there have been any crashes or injuries. A message was left Thursday seeking comment from the company.

DRY ERASE BOARD-RECALL

NEW YORK (AP) -- Acco Brands Corp. is recalling about 3.3 million wall-mounted dry erase boards after customers said they cut their hands, fingers and feet while removing the board from a wall.

The U.S. Consumer Product Safety Commission says metal can be exposed when the board is taken down from a wall. Seven people reported injuries and four of them required stitches.

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