Some 125 people trying to overcome their addiction to heroin pop in daily at Buena Care, a medical clinic near the USC Health Sciences campus, to receive an artificial form of the drug known as methadone.

The state sends Buena Care $686,000 annually to pay for the substance abuse treatment of these patients, but the costs, which across the state total $114 million from the general fund this year, have become a target of Gov. Arnold Schwarzenegger's budget axe.

Among the skirmishes in the larger budget battle that will unfold in Sacramento this summer will be one about Drug Medi-Cal. The program pays for the substance abuse treatment of about 35,000 Medi-Cal beneficiaries, including more than $18 million for 11,000 patients across an estimated two dozen medical facilities in L.A. County.

Schwarzenegger, a Republican, has proposed cutting the program to save $53 million next year, but the Democratically-controlled Legislature has thus far refused to adopt that cut. Altogether, the Legislature has rejected $1.5 billion in health care cost-cutting measures proposed by the governor.

Buena Care is part of the AltaMed group, which has hired a lobbyist to ensure legislators do not side with the governor.

Marie McAfee, the administrator at Buena Care's methadone treatment facility, said ending Drug Medi-Cal would be a setback for patients that would have drastic effects on public safety.

“These patients don't have means to pay for their treatment themselves, so they are going to resort to stealing and using drugs again,” McAfee said.

Patients at methadone clinics can range from people with prior criminal convictions to white-collar workers with clean backgrounds to teenagers in wealthy families. But at Buena Care, people who have spent time in jail and earn meager incomes comprise most of the client base. Buena Care has five counselors and a doctor among about 10 people on its staff. The facility's ability to stay open if Drug Medi-Cal was cut would depend on how many patients could afford the care.

Jason Damavandi, the manager at the Los Angeles Methadone Clinic near the Miracle Mile, said the average cost of treatment for one year at his clinic could be $2,200 for patients paying on their own.

He said he hasn't surveyed his clients to be certain how many won't be able to afford that price, but most of his approximately 110 clients signed a petition sent to state senators lobbying for the preservation of Drug Medi-Cal. He said the clinic could have to resort to layoffs in the event of a funding cut.

With the support of several statewide medical groups and associations, The California Opioid Maintenance Providers, a coalition of 140 drug-treatment clinics, has also launched a campaign opposing the cut. COMP's president told KCBS that cutting Drug Medi-Cal would cost the state $700 million for law enforcement and criminal justice.

In mid-June, Los Angeles County Sheriff Lee Baca and Los Angeles Police Department Chief Charlie Beck blasted the governor's plan. They said that methadone treatment keeps heroin addicts off the streets, where they commit 200 crimes annually to placate their addiction. Beck argued that the short-term savings would be negated by long-term costs.

Kathryn Challoner, an associate professor of clinical emergency medicine at the USC Keck School of Medicine, said any cuts in Medi-Cal services are disastrous and generate significant fall-out.

“If you can't obtain help from the system legally, you're going to continue the substance abuse,” she said.

Mary Andres, an associate professor at the USC Rossier School of Education, said that people who lose access to substance abuse treatment would not lose their need for medication.

“People who have been living comfortably on a subsidized medical program will start needing to use illicit drugs, which will increase crime and self-harm, such as prostitution, because they will be trying to compensate for not receiving methadone,” she said.

The county could also stand to lose $24 million in federal matching funds if the Legislature follows through with Schwarzenegger's plan, according to a memo by the county's chief executive officer, William Fujioka.

The governor's plan spares cuts to Drug Medi-Cal's counseling and rehabilitation program for pregnant and post-partum women as well as the treatment program for youth under the age of 21 that allows them to be covered by Medi-Cal regardless of parental income.

The nonpartisan Legislative Analyst's Office released a report in Feb. 2004 saying that Drug Medi-Cal was not spending its money efficiently. The report said the program “provides a patchwork of services with an inconsistent level of support for different modes of treatment and for different treatment populations.”

The costs of methadone treatment, Drug Medi-Cal's most expensive treatment method, tripled from 1994 to 2004 because of several regulatory changes. As a result, the report found that 75 percent of general fund spending for Drug Medi-Cal covered narcotic treatments that amounted to only 43 percent of the program's caseload.

In the last six years, the average annual treatment cost per client has jumped from $4,000 to $5,000. The number of patients and the length of their treatments have been steadily increasing too.

One of the cost-saving measures proposed in 2004 was replacing methadone with much-shorter treatment using the drug buprenorphine, a tablet which is considered safer and just as effective.

Andres, a licensed clinical psychologist who works at a drug treatment facility in west L.A., said whereas methadone acts as a drug substitute, buprenorphine dislodges heroin from sensory receptors, breaking the need for heroin altogether.
 
The state Assembly passed a bill last year to add buprenorphine to Drug Medi-Cal. According to the fiscal analysis for the bill, $10 million in General Fund savings could be realized if 10 percent of current methadone patients switch drugs. The state Senate has not yet taken action.

Despite the fact that heroin is one of the least popular drugs in the state, heroin-users are behind only amphetamine-users in the number of addicts in California who receive treatment.

“One of the advantages of methadone clinics is counseling is required, so you're not just dosing them and keeping them medicated, but you're giving them extra support and resources,” Andres said.

Last year, legislators shot down the governor's proposal to fund Drug Medi-Cal's General Fund budget by increasing the excise tax on alcohol. An American Recovery and Reinvestment Act grant that boosted funding for Drug Medi-Cal the past two years expires at the end of this year.

 

To reach reporter Paresh Dave, click here.