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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."

=====================

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 October 23, 2014 07:29 GMT

ECONOMY-THE DAY AHEAD

WASHINGTON (AP) -- The Labor Department will report today on the number of people who applied for unemployment benefits last week. Economists forecast that weekly applications increased 16,000 to a seasonally adjusted 280,000.

Also today, Freddie Mac will report on average mortgage rates for this week. Last week, the average for the 30-year loan slid to 3.97 percent.

The Conference Board will release its index of leading indicators for September as well. In August, the index - a gauge designed to predict the economy's future health - rose but at a much slower pace than the previous month

On the business side: Southwest Airlines, United Continental, American Airlines, Union Pacific, 3M, Comcast, General Motors and Caterpillar will report quarterly financial results before the market opens.

Amazon and Microsoft will report earnings after the market closes.

APPLE PAY GLITCH

SAN JOSE, CALIF. (AP) -- Bank of America is apologizing for double-billing customers who made purchases using Apple's new mobile payments service.

A bank spokeswoman said Wednesday that the glitch involved about 1,000 transactions and that all duplicate charges will be refunded.

Some customers who used Apple Pay with debit cards issued by Bank of America have complained they were charged twice for a single transaction.

Apple says it was aware of the glitch, which it said affected "a very small number of Apple Pay users." The Cupertino, California-based company has not disclosed how many customers have used Apple Pay since it became available Monday.

HARVARD-STAPLES-POSTAL WORKERS

CAMBRIDGE, Mass. (AP) -- The American Postal Workers Union called upon Harvard University's president to oppose a deal between Staples Inc. and the U.S. Postal Service, or resign her seat on the office supply company's board.

Staples, based in Framingham, Massachusetts, began providing postal services at some of its stores last year, under a partnership with the financially-struggling Postal Service.

The union, which represents some 200,000 workers, took out a full-page ad Wednesday in the Harvard Crimson, the Ivy League school's student newspaper, saying President Drew Gilpin Faust should use her position on the board to push for an end to the deal or resign from the company board. The union says Staples is using poorly-trained workers to handle mail in a low-security environment.

Neither Faust nor Staples responded to requests for comments.

YAHOO-CEO AT CROSSROADS

SAN FRANCISCO (AP) -- Signaling her reign has reached a pivotal juncture, Yahoo CEO Marissa Mayer is trying to convince restless shareholders that the long-struggling Internet company is heading in the right direction.

Mayer staunchly defended her strategy during a Tuesday presentation that addressed recent criticism leveled by activist investor Starboard Value LP, a New York hedge fund with a history of leading shareholder mutinies.

Starboard contends that since Mayer became CEO in July 2012, Yahoo has been wasting money on ill-advised acquisitions and a bloated payroll while mismanaging its lucrative stake in Chinese e-commerce company Alibaba Group.

In her rebuttal, Mayer described the $1.6 billion spent her more than 30 acquisitions as smart investments that have made Yahoo more competitive in the increasingly important mobile-device market. She also highlighted cost-cutting measures.

And she insisted that Yahoo wouldn't have been in a position to make as much money as it has on its Alibaba holdings if she hadn't taken steps to ease "years of tension and hard feelings.

CHINA-ZUCKERBERG

Zuckerberg speaks Chinese; Beijing students cheer

BEIJING (AP) -- China may ban Facebook, but not its co-founder Mark Zuckerberg, and he entertained an audience of students with a 30-minute chat in his recently learned Mandarin Chinese at a prestigious Beijing university.

There was no explicit discussion of the ban or any Facebook effort to enter the China market during Wednesday's question-and-answer session at Tsinghua University.

But Facebook CEO Zuckerberg noted during his talk that the social media giant already helps some Chinese companies gain customers abroad. He cited computer maker Lenovo's ads on Facebook in India.

Zuckerberg married Chinese-American Priscilla Chan in 2012 and said he was learning Chinese.

His pronunciation was far from fluent, but he maintained the conversation for a half hour and the students responded with warm cheers for his effort and laughter at his humor.

CHINA-MANUFACTURING

BEIJING (AP) -- A gauge of the health of China's manufacturing industry inched higher in October but factory output was at a five-month low in a sign of slowing domestic and foreign demand.

HSBC said Thursday the preliminary version of an index based on a survey of factory purchasing managers rose to 50.4 from 50.2 in September. Figures above 50 on the 100-point scale indicate expansion.

HSBC's chief China economist says manufacturing likely stabilized in October but the "economy continues to show signs of insufficient effective demand."

Earlier this week, China reported economic growth in the third as growth based on trade and industrial investment runs out of steam.

WORLD SERIES-RATINGS

KANSAS CITY, Mo. (AP) -- A World Series opener involving the San Francisco Giants set a record low TV rating for the second time in three seasons.

San Francisco's 7-1 win over Kansas City drew a 7.3 rating and 12.2 million viewers Tuesday night on Fox, according to fast national ratings by Nielsen Media Research.

That broke the previous low of a 7.6 rating and 12.2 million for the Giants' 8-3 victory over Detroit in 2012. San Francisco's 11.7 win over Texas in the 2010 opener got an 8.9 rating.

The rating for this year's opener began with a 6.9 from 8:05-8:30 p.m. EDT and peaked at 8.5 in the half hour starting at 9 p.m. With the Giants scoring three runs in the first inning and leading 5-0 by the fourth, the rating ended at 5.7 from 11:30-11:41 p.m.

Still, Fox said Wednesday it expects to win the prime-time night and have its best Tuesday night since February 2012.

Fox Deportes averaged 273,000 viewers, a record for Spanish-language World Series coverage.

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