Drug Addiction Treatment: Corporate Cash-Cow? Social Responsibility of a Non-Profit or Responsible For-Profit?
Peoria has the oldest non-profit methadone clinic in the state, opened in the 1970s by Fayette Companies, but in recent years competition has come to town in the form of two new for-profit clinics.
Drug addicts anxious to get into a treatment center have been discouraged by the waiting list at the Fayette clinic (now named the Human Service Center clinic), and they have found there is no waiting list at the for-profit clinics.
Addiction treatment is a burgeoning field, at $7.7 billion a year, according to IBIS World, Inc., a New York research firm.
The largest for-profit provider of addiction treatment in the country, according to its web site, is CRC Health Group, owned by Bain Capital, former presidential candidate Mitt Romney’s firm. According to CRC’s web site, it does not have methadone clinics in Illinois, but has locations from Massachusetts to California, Alaska to Louisiana.
Methadone clinics dispense daily amounts of methadone, a controlled substance, to help people eliminate the urge for illegal heroin and other opiates.
Whether a clinic is operated by a for-profit or non-profit should not matter, said Kate Mahoney, president of the Illinois Association for Medication Assisted Addiction Treatment.
“Health care is both non-profit and for-profit. The corporate status is not significant. People should be able to choose their clinic,” Mahoney said. “My interest is looking for ways to expand access. What worries me is people without access to treatment.”
Mahoney would like to see Illinois expand Medicaid to cover daily doses of methadone, something currently covered for a set number of patients through the Department of Alcohol and Substance Abuse. The state could save money and expand access to treatment, she said, by switching to Medicaid coverage.
Extension of Medicaid was close to becoming reality under Gov. Pat Quinn. Mahoney now plans to reach out to Gov.-elect Bruce Rauner and renew her efforts.
There are currently 67 methadone clinics in Illinois providing 11,600 people with methadone, said Richard Weisskopf, state opiate treatment authority with the Illinois Department of Human Services. There is no difference in the number of complaints lodged against for-profit clinics compared with non-profit clinics, he said. Procedures and state monitoring are the same at both types of clinics.
However, patients essentially must rely on word-of-mouth to determine which clinic is right for them. There is no comprehensive public data base to evaluate clinic performance.
Weisskopf said the federal government is expected to issue outcome-based evaluations of methadone clinics sometime in 2015.
“Treatment works. I’d love to see more money available for treatment,” he said, noting that methadone gets people off illegal street drugs, cuts down on criminal activity, reduces prison populations and helps people maintain jobs and family ties.
In Peoria, Dr. Ernest Rose owns the Rose Medical Association clinic that currently serves more than 500 patients. Rose estimates need in the community is three to four times his current enrollment. He takes no government funding and is entirely private pay.
In East Peoria, the Riverwood Clinic is owned by an LLC with clinics in a number of Midwest states. The clinic opened about seven months ago and enrollment is now about 100 and is expected to increase to 300.
Rose said, “There are daily deaths here in this community from opiates” . . . and some of those deaths are people on waiting lists.
A 33-year-old man who received treatment at a for-profit clinic but is now at HSC clinic, said he feels lucky to have gotten in. He now has a job and hopes for the future.
Clean cut and looking like a college grad student, the young man recounted his life progressing from oxycodone to I.V. heroin and a traffic accident after shooting up that landed him in the hospital for weeks.
He said the charge for his current methadone treatment at HSC clinic is $10 a week and is calculated on a sliding fee based on ability to pay. At his previous treatment clinic, he was paying $70 a week. During his years of addiction and homelessness, he had been spending up to $75 a day for illegal drugs on the street.
He said not everyone prefers the non-profit HSC clinic. A lot of addicts prefer the for-profit where he had been enrolled because they know they won’t be kicked out if they lapse and use street drugs. He said HSC is stricter and if patients lapse enough times, they may be told their slot at the clinic needs to be given to someone more committed to staying drug free.
He’s concerned about the waiting list at HSC.
“When people are ready for help, you can’t say there’s a three-month waiting list. The chance to get off can’t be put on hold. I’ve lost friends (to drug overdoses) who were on the waiting list,” he said.
Jim Weiss, director of quality management at Riverwood, said market research showed demand for methadone treatment in central Illinois exceeded available treatment capacity. Riverwood began in 2006 by people with 21 years of experience in private delivery of care, he said. The corporation now has nine clinics, soon to expand to 10, in Illinois, Indiana, Arkansas, Kansas, Nebraska and South Dakota and soon in Florida.
“Our goal is the same as every other clinic, to get (clients) to the point of no cravings,” he said.
Pat Kennedy, vice president of clinic services at HSC, said she regrets the waiting list. The clinic has increased to include a certain number of slots for people who can pay without any government assistance. The clinic currently serves about 135 patients, most on government assistance.
Former president of Fayette, Jack Gilligan, Ph.D., said it’s important for clinics to work with patients to taper down their methadone dosage.
“Our goal is to bring the person to a drug-free state, not to substitute one drug for another,” he said, but noted that some people may require lifelong methadone. Because of that, the best way to evaluate a clinic is not the percent of clients totally weaning from methadone but how many clients have long-term employment, have reunited with family and integrated back into their communities.
HSC gives high priority to pregnant women and IV drug users.
A 29-year-old woman at HSC said, “This program is a great experience for me. I’ve never gotten dirty here.”
She said at her previous treatment program “I used heroin every day I was there. Two years. And I was on 95 mg. methadone. But as long as I paid, I was never kicked out.”
She was spending $150 to $200 a day on street heroin.
Rose said the ideal dose of methadone is a level that eliminates cravings, and that’s done by keeping doses high enough. He’s not surprised that some patients in methadone clinics also lapse and use street drugs. He said that’s the nature of addiction.
The addiction rate in American is more than 12 percent of the population. Very expensive addiction treatment programs costing up to $100,000 have comparatively low long-term success rates keeping people off drugs and alcohol, Rose said.
“But people on an adequate dose of methadone have an 80 to 90 percent chance of not using opiates again,” he said.
Medicaid in Illinois covers the cost of counseling at methadone clinics but not the cost of the methadone doses.
State Sen. Dave Koehler, D-Peoria, said with any expansion of coverage, transparency becomes even more important to evaluate clinic performance. An outcome-based evaluation is the ideal.
Kennedy at HSC said the regulatory requirements to open a new clinic are extensive, and the economies of scale available to corporations with multiple clinics make opening a new location easier than it would be for a non-profit just entering the field.
“In our society, we still look at addiction in a moralistic way, but it’s a medical issue that needs treatment,” Kennedy said. “Other health care is not viewed moralistically. Addiction should not be a moral issue, it’s a chronic medical issue.”
However, by budgeting a set amount of money in Illinois for methadone treatment rather than expanding Medicaid, even the state is treating addiction treatment differently from other medical conditions like diabetes or hypertension.
“People need help. The current system with a set number of slots is not putting a dent in the numbers,” Rose said. “Anyone with a Medicaid card and opiate dependence should be admitted.”
When 70 percent of people in prison are there for nonviolent drug crimes and incarceration costs are at least $40,000 a year, treatment at $10 a day becomes fiscally conservative, Rose said.