For decades, methadone has been the drug of choice for substance-abuse specialists trying to help their patients kick addictions to heroin, morphine and other opiates. Over time, the drug has proven highly effective in reducing opiate cravings and suppressing withdrawal symptoms. It’s cost-effective as well, at about a dollar a dose.
But methadone has its risks. Appropriate dosage requirements vary greatly from person to person, necessitating close monitoring to prevent overdose. The drug remains in the system many hours after its effects seem to have worn off, and combined with even small amounts of alcohol, sedatives or other drugs—even cough syrup—it can be deadly. And it’s especially deadly when it’s on the streets. Methadone-related deaths are up dramatically nationwide over the past decade.
There are about 19,000 Pennsylvanians who currently receive state-funded, open-ended (meaning they can stay on the drug as long as it takes) methadone treatment at licensed clinics. Philadelphia has the highest number of patients, and the most methadone clinics, of any county in the state. But if State Sen. Kim Ward (R-Westmoreland County) has her way, those patients could see a marked reduction in methadone treatment services.
One of Ward’s two recently proposed pieces of legislation would limit Medicaid payments for methadone patients to 30 months. The other bill would restrict patients enrolled in the state’s Medical Assistance Transportation Program —which provides bus, train and car service fare to get them to and from methadone clinics for their daily dose—to a maximum of four weeks of transportation.
Ward’s basing her stance on an audit of Pennsylvania’s Medical Assistance Methadone Program by the state Legislative Budget and Finance Committee that was released in February. The report found that the average methadone patient spends 27.3 months in treatment, and that in 2009 the state spent $48.8 million for outpatient methadone treatment (an average of about $2,600 per patient for a year of methadone, counseling and other services) and an additional $32.5 million for methadone treatment transportation. Though she’s framing it as an issue of fiscal responsibility, Ward has a fundamental issue with methadone treatment for addiction.
“In many instances, you’re just trading out a heroin addiction for a legalized synthetic narcotic, and it doesn’t help that person get their life on track if we’re going to keep them on methadone maintenance for the rest of their lives,” she says. “I’d like to see people get help and recover, and not see our government pay for maintenance. And hey, some of these people are taking their methadone and selling it. It’s a bad situation we’re finding ourselves in.”
Four and a half years ago, Marti Hottenstein might have agreed with Ward’s position. In late 2006, the Warminster native’s 24-year-old son, Karl, died from a lethal combination of methadone and oxycodone. He’d been desperately seeking treatment for an addiction to Percocet, the painkiller he’d been taking for injuries suffered in a truck accident and, according to Hottenstein, had been denied inpatient rehab because “he wasn’t in bad enough shape.” Outpatient methadone treatment wasn’t an option either because federal and state guidelines mandate patients must have a minimum of one year of opiate drug use for admission. So her son illegally obtained a dose of liquid methadone from a co-worker, who had a take-home supply from a nearby clinic, to try to beat the addiction on his own.
At first, Hottenstein was angry and blamed the methadone for her son’s death. “But then I got educated,” says Hottenstein, herself a former alcohol and (non-opiate) drug abuser who’ll mark 24 years of sobriety next month. Through her nonprofit organizations Helping America Reduce Methadone Deaths (HARMD) and the How To Save a Life Foundation, she’s become an outspoken advocate for the responsible use of methadone in treating opiate addiction. She also works as a consultant for SOAR methadone clinics in Northeast Philly and Chester, where she implemented a successful methadone safety program nearly four years ago that has become a model for clinics statewide.
“Kim Ward doesn’t know what she’s talking about,” Hottenstein says. “Methadone works. If [Ward] knew anything about methadone treatment, she’d know that sometimes 30 months is not enough. What she’s doing is demonizing and discriminating against people, especially low-income people, who need this treatment. Addiction is a disease. Would Ward tell a cancer patient that they can only have 30 months of chemotherapy?”
Unlike other state-funded treatment programs, however, methadone has always had stigma attached to it: the medical consequence of bad lifestyle choices. “[Methadone treatment] is something that someone inflicted on themselves to begin with,” Ward says. And clinics are easily blamed for the drug getting out on the street.
But as a 2009 report from the U.S. Government Accountability Office determined, the bigger source of illegal methadone and the rise in deaths revolves around the take-home pill form—as opposed to the liquid form that patients drink at methadone clinics—which is increasingly being prescribed by physicians to treat chronic pain, not addiction.
“If you’re out on the street trying to sell your methadone and you’re selling me liquid methadone, I have no idea what you’re trying to sell me,” says Robin Rothermel, director of the Bureau of Drug and Alcohol Programs at the Pennsylvania Department of Health, who insists the state remains committed to funding methadone treatment. “Whereas if you’re diverting tablet methadone I can take one look at that and know if it’s methadone. The clinics aren’t perfect, but there’s a whole set of protocols and procedures and safeguards in place to prevent people who shouldn’t have methadone from getting it.”
In Pennsylvania, there’s no system in place to determine where the methadone that killed someone came from, but State Rep. Gene DiGirolamo (R-Bensalem) aims to change that with a bill currently in the House that would establish a review team to investigate all methadone-related deaths. DiGirolamo’s bill has gotten support from several groups, including the Pennsylvania Association for the Treatment of Opioid Dependence, which he says represents about 40 of the state’s 58 licensed methadone clinics.
“We need to get a handle on why these deaths are occurring and how we can prevent them,” says DiGirolamo, “and it’s the methadone clinics’ belief that a lot more of the deaths are occurring from doctors prescribing methadone for pain. But we have no way of knowing for sure until this team starts taking a look.”
Despite the fact that the methadone that contributed to her son’s death came from a clinic, Hottenstein is convinced the greater problem comes from prescription methadone. She says she’ll fight against Ward’s legislation, and she’ll continue to stand up for the responsible use of the drug. “I’ve lost friends over this, who think I should be anti-methadone because Karl died from it,” she says. “But methadone saves lives.”
Letters to the Editor