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I-Team Special Report: Detox Dilemma

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 individuals 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 NIDAs 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 SAMHSAs 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.