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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 November 26, 2014 19:13 GMT

UNEMPLOYMENT BENEFITS

WASHINGTON (AP) -- The number of people seeking U.S. unemployment benefits jumped last week, pushing total applications above 300,000 for the first time in nearly three months.

The Labor Department says weekly applications rose 21,000 to a seasonally adjusted 313,000, the highest level since the first week of September. The four-week average, a less volatile measure, rose 6,250 to 294,000.

The increase is unlikely to raise concerns about the broader health of the job market. At least some of the rise occurred because of seasonal layoffs in businesses affected by the cold weather, such as construction. The department seeks to control for such seasonal factors but doesn't always do so perfectly.

Applications had been under 300,000 for 10 straight weeks, an unusually low level that indicates companies are laying off few workers.

CONSUMER SPENDING

WASHINGTON (AP) -- U.S. consumers picked up spending by a modest amount in October, a slight improvement after no gain at all in the previous month.

The Commerce Department says consumer spending rose 0.2 percent last month, while September was revised from a decline to a flat reading. Income grew 0.2 percent in October, matching the modest September gain.

Spending is closely watched because it accounts for 70 percent of economic activity. Solid job gains this year are helping to lift spending, which is giving a bolstering the overall economy.

Economic growth came in at a solid 3.9 percent in the July-September quarter. Economists are looking for growth of around 2.5 percent in the current quarter, and they believe 2015 will see further spending gains and growth of around 3 percent.

DURABLE GOODS

WASHINGTON (AP) -- Orders to U.S. factories for long-lasting manufactured goods rose in October, but a key category that tracks business investment plans declined sharply for a second straight month.

The Commerce Department says orders for durable goods increased 0.4 percent last month following a 0.9 percent drop in September and an even bigger 18.3 percent plunge in August. The two months of declines reflected big swings in the volatile category of commercial aircraft.

The small October gain was unimpressive, with declines in a number of categories including machinery, computers and primary metals such as steel.

A key category viewed as a proxy for business investment spending fell 1.3 percent in October after a similar 1.3 percent September drop. It was the biggest setback since a 1.4 percent May decline.

NEW HOME SALES

WASHINGTON (AP) -- Sales of new U.S. homes edged up modestly in October, led by a big jump in activity in the Midwest.

The Commerce Department says new home sales advanced 0.7 percent last month to a seasonally adjusted annual rate of 458,000. That followed a smaller 0.4 percent gain in September and put sales at the highest point since May.

The strength last month came from a big 15.8 percent increase in sales in the Midwest and a smaller 7.1 percent rise in the Northeast. Those increases offset a 1.9 percent fall in sales in the South, which accounts for half of the new-home market, and a 2.7 percent drop in the West.

Housing has struggled to recover since the recession ended in June 2009.

PENDING-HOME SALES

WASHINGTON (AP) -- The number of Americans signing contracts to buy homes fell slightly in October as tight credit and lagging wages remained financial hurdles for would-be homebuyers.

The National Association of Realtors says its seasonally adjusted pending home sales index fell 1.1 percent the past month to 104.1. The index remains below its 2013 average but is 2.2 percent higher than last October.

Pending sales are a barometer of future purchases. A one- to two-month lag usually exists between a contract and a completed sale.

Housing has struggled to fully rebound since the recession ended more than five years ago. Many potential buyers lack the savings and strong credit history needed to afford a home, causing them to rent or remain in their existing houses instead of upgrading.

MORTGAGE RATES

WASHINGTON (AP) -- Average U.S. long-term mortgage rates ticked down for the third straight week, a positive trend for potential homebuyers.

Mortgage company Freddie Mac says the nationwide average for a 30-year mortgage declined to 3.97 percent this week from 3.99 percent last week. Rates are now about a half-point lower than at the beginning of the year.

Long-term mortgage rates fell as low as 3.31 percent toward the end of 2012, partly because of the Federal Reserve's bond-purchase program, which was intended to keep rates low. That program has since ended.

Rates have fallen in recent weeks amid economic slowdowns in Europe and China and the start of a recession in Japan.

The average for a 15-year mortgage, a popular choice for people who are refinancing, was unchanged at 3.17 percent.

CONSUMER SENTIMENT

WASHINGTON (AP) -- Greater optimism about income growth and future spending pushed U.S. consumer sentiment to a fresh 7-year high in November.

The University of Michigan says its index of consumer sentiment rose to 88.8 in November from 86.9 in October. That's the highest since July 2007, five months before the Great Recession began.

The report adds to a mixed picture of U.S. consumers heading into the holiday shopping season. A separate measure of consumer confidence, released Tuesday, fell sharply after reaching its own 7-year high last month. And Americans are spending at a sluggish pace despite a pickup in job creation this year.

Still, the Michigan survey found consumers said they were more likely to spend on big-ticket items such as appliances and autos than at any time since the recession began.

AIR BAG RECALL DEMAND

DETROIT (AP) -- U.S. safety regulators are threatening fines and legal action against Takata Corp. for failing to admit that its driver's-side air bag inflators are defective and should be recalled nationwide.

The National Highway Traffic Safety Administration sent a letter to the company Wednesday detailing the threats, which include a public hearing and possible court action.

Takata of Japan has refused demands for the national recall, saying that a recall limited to high-humidity states is sufficient. But the agency says two inflators have ruptured in cars outside the high-humidity zone, injuring drivers by spewing metal fragments.

Transportation Secretary Anthony Foxx says Takata must act quickly or the agency will use all of its authority and resources to get the national recall done.

OBAMA-SMOG

WASHINGTON (AP) -- The Obama administration is announcing steps to cut levels of smog-forming pollution linked to asthma, lung damage and other health problems.

The Environmental Protection Agency is calling for a new, lower threshold for ozone pollution of 65 to 70 parts per billion. That's down from the current standard of 75 parts per billion, put in place by President George W. Bush in 2008.

But the EPA is leaving open the possibility it could enact an even lower standard of 60 parts per billion sought by environmental groups.

The EPA estimates that meeting the stricter rules will cost industry about $3.9 billion in 2025 if the government goes with a standard of 70 parts per billion. At a level of 65 parts per billion, the EPA said, the cost grows to $15 billion.

Industry groups say the cost would actually be far higher and that it would be nearly impossible for refineries and other businesses to comply. But EPA Administrator Gina McCarthy says lower ozone standards would actually spur more businesses, investment and jobs by making communities healthier.

The EPA was under a court-ordered Dec. 1 deadline to issue a new smog standard.

CONGRESS-TAXES

WASHINGTON (AP) -- A White House veto threat appears to have put on ice a congressional effort to permanently renew a handful of generous tax breaks for businesses and individuals. Officials say that the plan, brewing behind closed doors on Capitol Hill, favored corporations over the working class.

The unusual veto threat came before the parameters of a potential agreement were even revealed.

Speculation on Capitol Hill on Tuesday focused on a potential agreement to permanently enact tax breaks on business investments in new equipment and research and development, part of a plan that would renew dozens of expired tax breaks for businesses and individuals.

The White House immediately threatened a veto, saying Congress should also make permanent more generous tax credits for the working poor and people with children.

IMMIGRATION-BENEFITS

WASHINGTON (AP) -- Many immigrants in the United States illegally who apply for work permits under President Barack Obama's new executive actions would be eligible for Social Security and Medicare benefits upon reaching retirement age, according to the White House.

Under Obama's actions, immigrants who are spared deportation would be eligible to obtain work permits and a Social Security number. As a result, they would pay into the Social Security system through payroll taxes.

Not all such immigrants would be entitled to the benefits, however, because like all Social Security and Medicare recipients they would have to work 10 years to become eligible for retirement payments and health care.

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