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Health Care Economics
Slashing Methadone Programs Carries Hidden Costs
Psychiatric News
Volume 38 Number 15 page 26-26

Real-world experience and a speculative cost-simulation model both lead to a similar conclusion.

Methadone treatment saves money when its price tag is offset by the costs to the criminal justice system of persons who are addicted to heroin.

Oregon Public Radio (OPR) examined the impact of the forced weaning of an estimated 1,500 addicts off methadone when that treatment was phased out beginning March 1.

The reduction in services came about when Oregon state officials eliminated prescription drug benefits, outpatient mental health benefits, and substance abuse treatment for 100,000 persons who are eligible for the Oregon Health Plan but do not meet income-eligibility criteria to be part of the "mandatory" population guaranteed coverage through the Medicaid program.

Typically, they are adults whose incomes are below the federal poverty level but who do not otherwise qualify for Medicaid by fitting into a category of eligibility defined in Medicaid legislation (Psychiatric News, April 4).

At the time, David Pollack, M.D., medical director of the Office of Mental Health and Addiction Services in the Oregon Department of Human Services, told Psychiatric News that the elimination of reimbursement for methadone is a good example of how many of the cuts are "penny wise, but pound foolish."

OPR reporter Kristian Foden-Vencil reported on April 4 that Cliff Jensen, commander of Portland’s East Precinct, said that crimes like burglary and shoplifting were up more than 40 percent since January. Jensen said that the "addictive lure" of drugs like methamphetamine and heroin is so strong that people who are no longer getting help at social-service agencies are reverting to their previous lifestyles.

She also quoted Gerald Parker, a recovering addict who was losing his methadone treatment. He warned the public of the effect of the cuts. "There’s going to be a lot more stealing; the stores are going to start raising their prices again. If you get caught, you’ll have to go to the judicial system, where it costs them to take you to court. Housing in the jails [costs money as well], so it’s going to cost more in the long run than to pay for the methadone program."

In a presentation at the AcademyHealth meeting in Nashville in June, Gary Zarkin, Ph.D., offered a different kind of testimony to the economic costs of addiction. He said that the mean figure was $1,061,639 for lifetime crime and criminal justice costs for an individual who had ever used heroin.

That finding came from a speculative analysis in which the benefit-cost ratio for outpatient methadone treatment was calculated over the lifetime of an individual through use of a simulation model.

Zarkin is director of the Center for Interdisciplinary Substance Abuse Research at RTI International in North Carolina.

He said that previous studies had examined the costs and benefits of a single-treatment episode. Those studies typically have yielded a cost-benefit ratio of 4.9. Drug abuse, however, is a chronic condition and usually is not treated successfully in one treatment episode. So, according to Zarkin, a simulation model is helpful because it can predict benefits and costs over a lifetime. With the model, the lifetime cost-benefit ratio rose nearly 10-fold to 40.

A simulation model is an analytical method meant to imitate a real-life system. It calculates multiple scenarios of a model by repeatedly sampling values from probability distributions for the uncertain variables and using those values for the cell.

Researchers have used simulation models to evaluate costs and benefits of treatment for other chronic conditions, such as coronary heart disease and diabetes.

Zarkin and his colleagues used age, gender, current heroin use, heroin use history, methadone treatment history, and employment status to establish probability distributions. They considered six outcome factors that are central to determining the cost-benefit ratio: heroin use, methadone treatment, criminal behavior/criminal justice, time spent incarcerated, employment, and health care costs. ▪

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