Despite signs of increasing heroin use, the state is making it more costly for many addicts to receive methadone treatment.
Methadone is a synthetic narcotic that is dispensed by state-funded clinics as a substitute for heroin. The state requires methadone clinics to charge a fee, which has been rising over the years and will go up again, for many clients, on July 1.
"I think that people should pay something, but I think it's getting exorbitant," says Richard H. Lane, executive director of the Man Alive methadone clinic in the 2100 block of N. Charles St.
The fee schedule is based on a client's income and number of dependents. At Man Alive, a single person who earns $20,000 a year will pay $67 a week beginning July 1, or $3,484 a year. The maximum fee currently is $53.
A client with a spouse and two children, who earns $22,000, will pay $54 weekly, or $2,808.
Methadone clinic directors such as Lane and Carol Butler, who runs the Sinai Hospital Drug Dependency Program, say escalating fees are discouraging addicts from beginning or continuing methadone treatment.
"The people who are working, trying to make ends meet, and trying to get themselves back to a self-sufficient category, are being hit for a payment for treatment here that's comparable to a car payment every month," Butler says.
The methadone directors have complained to the state Alcohol and Drug Abuse Administration without success. The problem is money: Clinic costs are rising due to inflation, but state officials say there are no extra funds to support the programs, which already receive most of their money from the state.
The state's budget for methadone programs received a blow last year when the manufacturer of methadone doubled its price, causing the state to eliminate plans for a modest expansion of methadone treatment programs.
State grants to the clinics, which total $12.3 million this year, won't be increased in the new fiscal year that begins July 1. The added costs of running methadone programs will be met with increased client fees, which now total $2.2 million a year.
Clients, men and women from a variety of backgrounds, are howling.
"If the fees go up and they force people to go back on the street, there's going to be a lot more problems," warns one Man Alive client, a young government worker with a family.
Methadone is highly addictive, but it quells the addict's craving for heroin. Methadone users are able to live relatively normal lives because the drug is administered orally and it has a longer lasting effect than heroin. While heroin addicts often steal to support the high cost of maintaining their habits, methadone users can obtain the drug at much less expense at state-supported clinics and a few for-profit clinics.
Ideally, methadone users would work toward a drug-free life, but many ex-heroin users find they can't make it without methadone and continue receiving it in daily doses for years. Clinics such as Man Alive also provide counseling, medical care and regular testing for illegal drugs.
The 18 state-supported methadone clinics have room for 3,500 clients at any given time. But estimates of heroin users in Maryland range as high as 50,000 -- and that number may be increasing.
Federal law enforcement authorities in Maryland say they observed an increase in heroin trafficking at least two years ago. State officials report a sharp rise in the number of heroin users seeking treatment.
This adds to the worries of Butler and other methadone officials. In a letter earlier this year to Rick Sampson, director of the alcohol and drug abuse agency, they asked for help with client fees.
They said a key problem is the low level of compensation they receive on behalf of indigent clients who qualify for state medical assistance: The state pays $30 a week, less than half the real cost of providing service.
Meanwhile, other clients who earn too much to qualify for state medical assistance, but who still can't afford fees, don't pay anything. The result, clinic directors say, is that working clients subsidize other clients.
Sampson offered no relief. He told the directors his agency has no control over the state medical assistance fee, which is governed by another agency. He added, in a letter, that "it would appear that due to the state's financial constraints, the reimbursement rate will not be increased this fiscal year."
But agency officials say they're sympathetic to the clinics' concerns.
"There's an ongoing tension between available revenue and necessary expenditures," says Margaret McIntyre, chief of the agency's grants management division. "It's like keeping a number of balls in the air. It's not easy for the program, nor is it easy for the state in terms of funding for the programs."