Order Newsletter in print:
Accessibility -- Insurance & Treatment Cost - by Aaron Rolnick
ANNOUNCEMENT: ARM Begins Publishing Advocacy Newsletter
UROD Hell--Beware - Terri Martinez
Exception Denied--A Patient's Frustrating Story
NOTICE: New Treatment Program Open in Michigan - Excellent!
Doctor's Column
Do the Federal
Regulations Discourage or Prohibit Dosing over 100 or 120 mg?
Also: LAAM
Many health insurance plans have annual [monetary] limits/caps on substance abuse coverage; perhaps worse, such plans often also have a lifetime limit on coverage of substance abuse treatment (considering the cost of methadone maintenance treatment, the limit may be reached relatively quickly for methadone patients in long-term treatment).
In addition, quite a few health insurance plans simply will not cover methadone maintenance treatment—or will only cover it for a limited duration and/or only if the patient is attempting to detox. As most methadone clinics do not itemize charges for different services, such health insurance plans will not even cover the counseling portion of the cost of treatment (this is significant considering that over half of the cost of methadone therapy is going towards counseling services).
Thus, many people in need of methadone maintenance treatment cannot get their health insurance to cover it or can only get a small portion of the costs covered—and that's in addition to the 1/3-1/2 of those who need or are in methadone treatment and are uninsured. To get into or remain in treatment, these people need to pay most or all of the cost out of their own pockets; for treatment at a private methadone clinic, the cost is somewhere between $50-120 per week (in Michigan, $65-$70 per week). To get on a public clinic, one may have to contend with a waiting list and/or strict income requirements [and it still may not be free—often there is a sliding scale]. Assuming a public clinic is available to an individual, most of them provide poor treatment and continually pressure patients to detox (though I am judging by second-hand accounts), and have low dose caps (30 or 40 mg). Thus, public clinics are not an option for most people—and for those able to obtain a slot, it is a temporary or "stop-gap" option, at best [it could be better than nothing].
Fortunately, those who qualify for Medicaid can often get coverage for their methadone treatment. Medicaid coverage of methadone treatment varies from state to state; Medicaid covers some or all of treatment in approximately 70% of states where methadone treatment is permitted. Michigan recently placed limits on how long Medicaid will cover a patient's care [the length of coverage varies depending on individual circumstances]. Michigan lawmakers are presently considering a proposal to limit Medicaid coverage of maintenance treatment to 6 months. Even assuming that Medicaid covers methadone treatment for an indefinite period of time, qualifying for Medicaid isn't as easy as some people [who have never had to find out] may think. To be considered for Medicaid, you must be disabled and/or have dependent children. Then there are the income requirements—many people who don't get health insurance through their employer or spouse (but can't afford to purchase their own health insurance), make too much money to qualify for Medicaid.
In conclusion, many people in need of methadone treatment are in a situation where they simply cannot afford treatment [at least not at a private clinic]. Many others who are in treatment struggle to afford it—or are not affording it and are in the process of a "feetox" (being detoxed by the clinic because they are behind on the clinic bills).
The proponents of the proposed federal rules [regarding opiate maintenance treatment] would have us believe that this proposal will make treatment more accessible; yet none of the problems discussed above would be remedied by this proposal. At best, the proposed rules might make treatment slightly more available by encouraging more doctors and substance abuse treatment providers to open up methadone clinics; however, the proposed rules would make treatment less available by increasing the cost to methadone treatment providers—and therefore to patients who have a difficult time paying their clinic bill as it is.
Either way, it is certain that the proposed regulations will not make the cost of treatment to patients less (which is one of the greatest barriers to getting treatment). Furthermore, there is no evidence that the proposed regulations will increase the number of treatment "slots"—proponents have offered no explanation why moving from "licensing" [as is used currently] to "accreditation" [as the proposed regulations provide for] will increase the patient capacity of existing treatment providers or increase the number of providers.
The proposed regulations could even reduce the availability of
treatment, as the additional cost of accreditation to providers may cause
small providers to shut down. Thus, the lack of accessibility of
maintenance treatment—one of the major problems with the current system
[but by no means the only problem]—will not be remedied by the current
proposal.
Last month, Advocates for Recovery through Medicine (ARM)
printed its first newsletter. ARM's newsletter will be published
on a quarterly basis.
Advocates for Recovery through Medicine is a recently formed national advocacy organization that "aim[s] to change the policy regarding *Opiate Agonist (OA) treatment and, in the process, improve the lives of methadone patients everywhere in the country." [*Currently available OA treatments include methadone, LAAM, and buprenorphine treatment].
Methadone Today subscribers should have received ARM's newsletter in lieu of an October issue of Methadone Today. Any current subscribers who did not receive ARM's newsletter should contact us [see contact information on page 4 of this issue].
CORRECTION: On the first page of ARM's newsletter, readers
interested in becoming a volunteer or member were directed to contact ARM;
however, the phone number listed there contained an incorrect area code—the
correct phone number in its entirety is (615) 354-1320 (you will be directed
to the correct number by recording if you call the incorrect number).
As indicated, individuals may also contact ARM by e-mail at arm-org@home.com,
visit their home page at ARM-advocates.org,
or by writing in care of Beth Francisco at P.O. Box 164, Davison, MI
48423-0164. Individuals interested in receiving a subscription should
send a check or money order to the above address (a year's subscription
is $20.00—checks should be made payable to "ARM").
UROD is a procedure in which the patient is anesthetized and given
narcotic antagonist drugs (i.e., naltrexone) that basically remove opiates
(as well as endorphins) from receptor sites, precipitating a sudden, severe
withdrawal. The supposed purpose of UROD is to reduce the duration
of withdrawal and prevent "relapse" before the cessation of detox (since
the patient is anesthetized through some of the detox and after that is
given naltrexone to block opiates from taking effect should the patient
administer opiates).
With one exception, the many patients who have called or written Methadone Today have found UROD to be very inhumane and ineffective—especially in the long term. One reason for the high failure rate of UROD is that it does nothing to correct the chemical imbalance in the brain believed to be at the root of opiate addiction—[this is why maintenance treatment has a far higher success rate than detox], and may worsen this imbalance since the antagonists used during and after the procedure block endorphins (produced by the brain)—the lack of which may have caused the original problem (chemical imbalance).
Even among detox methods [which result in a high relapse rate],
UROD appears to be no more effective or humane than other treatments/regimens.
Furthermore, there's significant evidence that UROD is not as safe as other
detox methods. Aside from the risks associated with general anesthesia,
UROD patients have an exaggerated risk of overdose should they use opiates
at some point after the procedure—even after several months [*while patients
are on naltrexone, they are protected from OD]. Thus, UROD is not
"the sleep cure" its practitioners tout it to be but a detox method of
questionable value and safety.
"After I woke up from the procedure, the pain and withdrawal symptoms were so bad, I prayed I would die. It was the worst pain I have ever felt in my life. They lied to me. If I had been physically able, I would have committed suicide". Quotes from my new friend that had the Ultra Rapid Opiate Detox (UROD) procedure recently. She went to a small hospital in Richmond, Virginia to have the procedure.
Within the past year and a half, she has slowly detoxed from 90 mg to 35 mg She has been on methadone maintenance treatment (MMT) for five years.
On Tuesday morning, after prep work, they put a diaper on her and proceeded with the anesthesia. The procedure started at 7:30 a.m. At 2:30 p.m., she awoke from the anesthesia. She told me she had an excruciating burning sensation in her back and legs. Her mouth and throat were blood-filled. She had many broken capillaries in her face, tremendous cramping, and nausea. Her blood pressure was extremely high, and her temperature varied between 104-106 degrees. She did have convulsions.
She stated that it was the worst pain she had ever experienced, much more intense than any detox she has had before. She feels that the doctors performing the procedure lied to her, as they did not prepare her for the pain and symptoms of withdrawal being so intense.
These doctors did keep her in the hospital for two nights. Many physicians who are offering the procedure send the patients to a hotel with a caretaker. She told me that there is no way her caretaker (her mother), could have handled her, as she was delirious. She also said that the hotel her parents stayed at was on the 18th floor, and she was in the state of mind that she might have jumped out the window. She said this very seriously, as she does feel extremely depressed—EXTREMELY (five days after the procedure, she stated: "I still sometimes think a gun may have been a better option [than UROD]").
It has been four days since the procedure, and she is still in pain, nauseous, has diarrhea, leg cramps, burning sensation in her back and legs, and is very tired. The doctors prescribed Librium, so she did sleep a few hours. I believe that she may have taken some "benzos" (Valium-like drugs) also. In the four days since the UROD, she has lost 40 lbs.—quick weight-loss.
I did convince her not to have the naltrexone implants, and she is taking the pills. The doctors would not guarantee her that the UROD procedure or the naltrexone would not damage her liver, as she has hepatitis C.
I just met this woman soon before she had UROD. She is a wonderful, intelligent person, and she has many personal reasons why she felt UROD was her only option at this time. She explains how her doctor her basically forced her into it: "my doctor would not let me start the interferon treatment, which I need so badly to treat my Hepatitis C, until I detoxed from methadone. I was told it is a contraindication," which she later found out was untrue—if anything, hepatitis patients on methadone maintenance are advised to remain on maintenance treatment.
She slowly tapered off of methadone, until when she reached 35 mg., "the doctor told me I had to (completely) detox from methadone for him to continue to treat me." As she needed the interferon treatment as soon as possible, she felt she had no choice other than UROD.
She did tell me that she would definitely discourage anyone from
undergoing UROD and asked me to spread the word, as she doesn't have internet
access. She also mentioned that she could not imagine being on a
[methadone] dose higher than she was [35 mg] and having this procedure
done. After seeing her and hearing her story, I believe that
she would have experienced no more pain detoxing in a non-medical detox
center [e.g.: "cold turkey" withdrawal] than she did with the UROD
procedure.
Hey everyone, I am so angry. I have been in methadone
maintenance treatment (MMT) for a little over a year now and have followed
all the rules and regulations (kept all appointments, current on all fees,
urinalysis positive for only prescribed medications, etc.). Recently
I applied for educational assistance from the state rehabilitation programs,
and I was approved to start school August 30. I am currently on three
days' a week clinic attendance.
Due to the fact that I have medical conditions that reduce my stamina, I did not feel like I could make the 225 mile, four-hour round trip three times a week to the clinic and attend school full time. So I went in and talked to my counselor (my second new one in a month) about getting an exemption. She was very nice and said that she would check on it.
She came back in a little bit and said that they could not do it. I requested to speak to whomever had the power to make decisions, but I overheard them talking in the background. The owner said that the "Oklahoma Department of Mental Health was tired of getting those hardship forms," and "that we (our clinic) wasn't going to try to get any more of them."
So now what do I do? There is no one else left to ask. Do I just not go to school? I know that my health won't hold up to that kind of schedule.
Once again, there is only lip service paid to trying to help us become productive citizens. Instead, they keep us in our place with ridiculous arbitrary decisions.
I am sorry for ranting, but I am just really bummed out. I was so excited about going to school. I actually had some hope that we might be able to dig out of this financial quagmire. Alas and alack, I guess it is just not to be.
Editor's Note: According to the author, this experience is not typical for his clinic—he usually receives good treatment there. However, this treatment is typical of many clinics. In addition, it is possible that the Oklahoma Department of Mental Health really was at fault by putting pressure on clinics not to request exemptions—as the clinic owner alluded to: "[the] department was tired of getting those hardship forms ." But no matter who is to blame for this injustice, incidents like these point to the inadequacies of the current law. Forcing a patient in such circumstances to rely on individual "hardship exemptions" for which the clinic must apply is unfair. Clinics and state departments that ‘don't want to bother' with such paperwork may try to discourage patients from pursuing such "exemptions."
For this and other reasons, many patients simply are not informed that
getting an individual exemption is possible.
In conclusion, getting a "hardship exemption" must be made easier.
Better yet, treatment providers should have the discretion to account for
individual circumstances on their own—and adjust clinic attendance and
other elements of treatment without seeking permission or acknowledgment
from some government agency.
A new, modern, medically-based opiate addiction treatment
program recently received its full licensure from the State of Michigan.
Following is the name of the program and contact information:
Medical Director, Brian A. McCarroll, D.O., is board certified in Family Practice and is Certified in Addiction Medicine by the American Society of Addiction Medicine. He is the only certified addiction medicine specialist in the area who operates his own medically-based opioid treatment program.BioMed Behavioral Health
22900 East Remick
Clinton Township, Michigan 48035
Phone: (810) 783-4802 Fax: (810) 783-4805
Located off Gratiot Avenue on Remick, ½ mile North of 16 Mile Road on the East side of Gratiot.
At BioMed we are dedicated to treating the disease of addiction as the medical illness that it is! Our patients are and always will be treated with the respect and dignity that any patient with a medical illness deserves. If you are sick and tired of being treated like a "second class citizen" or "worthless junkie", give us a call. We will be more than happy to help you.
At BioMed we are approved for both Methadone and LAAM. Dr. McCarroll will personally discuss your problem with you, individualize your treatment program, and prescribe your medication according to your specific individual needs.
Editor's Note: Dr. McCarroll's statements suggest that he is acutely aware of the problems methadone patients must deal with during the course of treatment. In addition to sending this information, Dr. McCarroll graciously invited us to visit BioMed [which we did]. Unlike many methadone clinics, BioMed is very clean—having the look and feel of a doctor's office.
We are impressed with Dr. McCarroll; he appears to be genuinely
concerned with his patients. He stresses "individualized care"—a
refreshing attitude in a field where "one-size-fits-all" treatment is the
norm. At BioMed, a psychiatrist and psychologist are available for
consultation—a service not available at most other clinics (while methadone
providers stress the need for comprehensive services, the only counseling/psychotherapy
normally offered is from "substance abuse counselors," who are usually
not qualified to diagnose and treat the secondary psychiatric conditions
that some patients have; as a result, some patients are not offered the
therapy they need and wind up being discharged for "lack of progress" or
for being ‘untreatable').
