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October 14, 2009 -- Pacific NW Inlander (WA)

Needing A (Funding) Fix

A Successful Drug Treatment Program Faces Funding Troubles, And County Leaders Have Their Fingers In The Dam

By Nicholas Deshais

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Emily Hawkes started doing heroin at the age most kids learn how to drive. She was addicted to the drug when she had her two boys, now eight and 11. To ensure a steady supply, she did everything she could think of. She sold drugs to other users.

She sold her body.

She liked heroin, of course, but it wasn't always the greatest thing. She still owes thousands of dollars in hospital bills, the result of too many emergency room visits for her many infections, one of which almost took her leg. She wanted off many times, but nothing worked. Not cold turkey, not rehab. For 15 years, nothing.

Nothing, that is, until she started her regular visits to Spokane's methadone clinic. Now she's been clean for more than a year, has her kids back and a steady job and is planning to move out to New Hampshire to be with her mom.

Sobriety's been a good ride for Hawkes - she credits it with saving her life - but all that could change if county leaders don't secure the funding needed to keep the methadone clinic open to a group of poor, government-assisted patients.

"You kick somebody off and their life will change," she says. "They're going to go back to the street and it will be horrible."

As funding sources have dried up for patients needing government assistance, county leaders have scrambled to find new avenues to finance the recovery of the poorest addicts. But it's not that easy.

"We're looking at going to the Legislature, and we're exploring foundation contributions," says Dr. Joel McCullough, director of public health in the region. "But in these economic times, there are really not a lot of people giving out money."

Trouble began in June, when 23 patients at the methadone clinic were told that they were losing their spots there. County commissioners scrambled to find a temporary fix, eventually doling $30,000 out of the general fund and guaranteeing those patients spots till the end of June 2010.

It's an unfortunate situation that arose from the clinic accepting too many patients, not unlike an airline overbooking a flight. This is how it unfolded: Earlier this year, officials at the Spokane Regional Health District realized they didn't have enough Medicaid-subsidized patients at the methadone clinic. So, despite Medicaid supplying funds for just 162 patients at the clinic, the clinic accepted 185, assuming a bunch would drop out of the program.

"That didn't happen," says McCullough.

A normal day at Spokane's methadone clinic goes something like this: A man walks in and he sits, waiting. In this room, to the people around him, he is just a number, and when it's called he'll approach the nurse at the window. His picture is displayed for the nurse on the computer's monitor, as is his name. The man and nurse will engage in conversation while the computer dispenses his allotted amount of methadone. The nurse will hand it to him, he will drink it and they will talk once again, the nurse watching closely to make sure he swallowed his medicine. Off he'll go, his brain's opioid receptors blocked, his cravings gone and his mouth still sweet from the cough syrup-y concoction he just put down.

It's not just heroin addicts who come here for treatment, but, increasingly, pain-killer addicts. "People from the lowest echelons to the highest," says McCullough. "People in your community are on methadone and you would never know."

For each day and every patient, this simple interplay, which allows addicts to lead normal lives without feeling like addicts or being high, costs the county $12.79. It's not big money, the cost of a dinner out, but Julie Albright, the clinic's program manager, says the money brings much more.

The $12.79 a day - or about $400 a month - covers everything: the methadone, the nurses, the therapy, the urine analyses, the doctor visits. Everything. That's cheap, she adds, considering that a lot of these people are being kept on the straight and narrow as productive members of society. A day in the Spokane County Jail for one person costs the county about $86. Less than five days of that and you have a month of methadone treatment. And therapy, nurses, urine analyses, doctor visits.

Not a bad deal per day, but it's the long-term nature of the treatment that is jeopardized by the funding debacle. The county's temporary funding solution is just that - temporary.

"Some people have been on it for 22 years, before [the clinic] was even here at the health district," Albright says.

McCullough agrees. "Some people are on [methadone] for many years. Some people are on it for a lifetime." Which is why he's begun putting together a lobbying effort for Olympia and approached different foundations, such as the Sacred Heart Foundation.

"It's preliminary," he says of his overtures to Sacred Heart. "We're certainly going to draft a proposal, to see if this is something they'd be interested in."

Whatever happens, says County Commissioner Bonnie Mager, a fix is desperately needed.

"This is a very important and successful project, so we need to figure out a way to fund this beyond June," Mager says. "We are approaching our legislators. But if the public knew how little it costs to fund this program, they would probably be willing to donate to some sort of foundation."

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