Thousands of heroin addicts who have kicked the habit with the help of methadone will be squeezing the last precious drops of orange juice from their paper cups next year, thanks to drastic but little-noticed cuts in the Oregon Health Plan.
The budget cuts, quietly imposed by a panel of state lawmakers last month, will boot about 1,850 clients (of 3,775 statewide) out of methadone programs.
"It'll have a devastating effect," says Tim Hartnett, executive director of CODA, which treats 900 clients in Portland and Eugene, providing them highly regulated daily doses of substitute narcotic that doesn't get them high. "This is like withholding insulin from diabetics."
Methadone treatment is typically reserved for chronic, hardcore junkies who have tried--over and over--to stay clean by conventional means.
Take Jim G., 52, a hard-bitten recovering heroin addict and former tugboat captain. By his own count, Jim tried to kick junk hundreds of times before he joined the methadone program. "It's made a big difference in my life," says Jim, standing outside the Delta Clinic on Southeast Belmont Street on a chilly Monday morning. "It's been a tough road, and methadone has helped me."
Providers are now wrestling with a diabolical paradox: how to taper down clients without pushing them back to heroin.
Most experts agree this is a long shot. "This is a set-up to relapse," says Pat Gold, program manager at Delta. "We're going to lose some people back to the streets. That's just the reality."
Designed as a long-term therapy, methadone is actually harder to detoxify from than heroin. Typical doses range from 60 to 100 milligrams a day. Some addicts take 200 milligrams a day--a lethal dose for a civilian.
For clients, the prospect of losing their methadone is terrifying. "I'm scared to death," says Donna, 31, a recovering heroin addict who has been on methadone for two years. "People are panicking."
Some methadone clients say they are ready to get off the drug. Others hope to find some way to pay for their treatment, which costs approximately $250 a month. But there is little doubt that hundreds will succumb to their addiction.
"People should be very concerned about the public-safety implications of all this," says Multnomah County Chair Diane Linn.
But methadone is only the tip of the iceberg. Starting March 1, the standard package of the Oregon Health Plan will no longer cover any chemical-dependency, mental-health or dental services for approximately 100,000 low-income Oregonians.
Altogether, lawmakers cut $18 million worth of services. But these cuts will produce just $7 million of savings to the state's general fund, because the state health plan gets roughly 60 percent of its money from federal matching funds.
The decision sparked fury among treatment providers and advocates for the mentally ill, in part because the cuts were imposed without any public testimony.
The state Department of Human Services originally proposed that the Oregon Health Plan reduce its reimbursement rates to hospitals, which are currently paid 74 percent of their costs. But the hospitals successfully lobbied lawmakers, who decided to ax services instead.
"The best way to put this is that hospitals went to [lawmakers] and made the case that their needs were greater than the needs of the people on the Oregon Health Plan," says Tom Towslee, spokesman for Gov. John Kitzhaber. "Unfortunately, the people who would be affected never got a chance to make their case."
The pain will be multiplied if Measure 28's income-tax increase fails in January, which would force much deeper cuts. Worse, Multnomah County, which funds many treatment services, is also facing a deficit of $20 million. "The timing is breathtaking," says Linn.
Social-service advocates predict the lawmakers' action won't save any money. Without access to psychiatric medication or therapists, patients with mental illness tend to destabilize and show up in ERs or jails. Addicts who can't get treatment can't get clean, and they may have the same destinations.
"Alcohol and drug abuse has an extraordinary effect on so many other concerns," says CODA's Hartnett. "Look at any issue people are concerned about. Crime. Domestic violence. Child abuse. Teenage pregnancy. Traffic fatalities. Unemployment. Did I mention divorce? Alcohol and drug abuse is the root cause or a substantially contributing factor in all those issues."
Outside the Delta Clinic, a throng of clients descended on a reporter to offer views about the budget cuts.
"There's gonna be so many sick people," said one.
"I don't know what I'm going to do if they cut it off," said another.
"They better hire a lot more security guards!" said a third.
Meanwhile, Portland treatment providers are bracing for the March 1 deadline, when thousands of addicts will no longer be able to get into treatment.
"I can't imagine what our possible response would be," says Sgt. Brian Schmautz, Portland Police Bureau spokesman. "All we can do is respond to calls and do our best."