DC Bureaucracy Threatens Methadone Treatments

Christina Smith, mother and recovering heroin addict, banded with three other mothers to advocate for those who are afraid to speak. Photo: Candace Y.A. Montague

Christina Smith has been through hell. At age 21, she began taking prescription painkillers after suffering from common injuries such as back pain and toothaches. When the prescriptions ran out, she began looking to the streets for relief. A couple of years later, she found it in heroin.

Piece by piece, her life began to fall apart. She was hooked on heroin and losing everything else. Employment as a certified nurse assistant, money, friends, and custody of her two sons were gone before she knew it. “The only thing I was left with was a little bit of sanity. Everything else was gone.”

After two and a half years of “that life,” Smith was tired. She missed her old life. Most importantly she missed her children. “I asked God to help me get clean and I would never use again. He took the taste and desire out my mouth and I haven't used since.”

After a brief hospital stint, she was linked to Good Hope Institute. She has been clean for the last six years.

Now the next battle is brewing. Smith, 32, was told that her methadone treatments were in jeopardy of being taken away due to financial issues beyond her control. She has banded together with other mothers to speak out. They’re demanding respect and not backing down.

Preparing for the Worst

In October 2016, methadone clinics in DC began receiving some disappointing news. They were given notification that the Department of Behavioral Health (DBH) will no longer offset the cost of methadone treatments for clients who aren’t on Medicaid.

In response to this news, clinics began to reduce the dosage of treatments without a plan to transition to other forms of medical-assisted therapy. One resident reported that she was told by her clinic’s director, “We have a business to run. If you don’t have the money to pay, we can’t see you.”

When a recovering addict hears that their methadone treatments could be cut, it’s absolutely terrifying. They remember what life was like when they were on the streets. They think of sickness, withdrawals, and desperation. They think of going back to prison or being homeless again. They think of all the progress they made to get clean. They think of relapse which could lead to death. But with a treatment bill of $14 a day and $420 a month, their backs are against the wall.

DBH sent a bulletin to the clinics in December saying that the government would pay for treatments. Yet, clients continued to be billed as late as April. While complaining among themselves, they did not inform government officials.

Heroin Addiction Growing, Not Shrinking

The opioid crisis has hit the country hard over the last two decades. Among whites, the addiction lies in prescription pills, while blacks are more likely to abuse heroin.

According to Kaiser Family Foundation reports, there has been a steady increase in opioid deaths in the District over the last four years. There was a 54 percent increase in opioid deaths between 2014 and 2015, as opposed to only a 9 percent increase from 2013 to 2014. Clinics are scrambling to keep up with growing caseloads as bad batches of heroin mixed with fentanyl hit the streets.

According to the Metropolitan Council of Governments, over the last three years drug overdose has risen in every ward in DC except Ward 3. Wards 5 through 8 account for 75 percent of the deaths. The Office of the Chief Medical Examiner reports that in the first half of 2016, 233 people died of an opioid-related overdose. Most of the reported deaths occurred in Ward 8.

In December 2016, patients began leaving the District’s medically assisted treatment centers. As it stands, 136 have left and most have not been heard from since their departure.

A Labyrinth of Failures

Smith and three other brave moms took their concerns to the top: Councilmember Vince Gray (D-Ward 7), chair of the DC Council’s Health Committee.

On April 12, Gray sent a scathing letter to DBH demanding answers for the sudden change in payment expectations. It stated, in part, that he wanted answers for the reports he was hearing from his constituents. “When did the Department decide to stop paying for methadone services? What was this decision based on? How many patients in the District are receiving methadone treatment? Why, in a city with over 70 authorized buprenorphine providers, and one of the largest addiction medicine practices in the region, hasn’t the Department transitioned residents receiving methadone treatment to available community based providers?” asked the letter.

Two days later, the director of DBH, Dr. Tanya Royster, responded to his letter. She assured him that the department is still covering patients who do not qualify for Medicaid with local dollars and that she was “dismayed” by his report. She noted that her department has human care agreements with all three of the medically assisted treatment (MAT) centers in the city.

There is an acrimonious relationship between DBH and the MAT centers. Clinics claim that the department owes them thousands of dollars. Last year, DBH had trouble with payments to mental health providers due to a technology glitch. This year, MAT providers claim to have had trouble billing local funds for services rendered. But with a $2 million cut to the budget, neither the DBH nor the MAT centers will see much relief.

On April 28, a budget oversight hearing was held at the Wilson Building. Four clients from the methadone clinics, including Smith, volunteered to speak about the payment issues.

Cuteava Chambers, a Medicaid recipient who has been in treatment for six years, was one of them. When she heard that her friends who go to Good Hope Institute were being told that they have to pay for treatment or be kicked out of the program, she became alarmed and jumped in to help. “Everybody’s complaining but nobody’s coming down to city hall to say anything. I offered to take as many people as I could in my truck to the hearing.”

Chambers, mother of two sons, believes they are afraid to speak out for fear of backlash from the clinic’s administration. One administrator had already tried to size her up: “I just wanted you to know that I saw you on PBS talking about the clinic.”She was unmoved.

This issue is far from resolved. More inquiries will be made by Councilmember Gray and others about the funding and coverage of treatments. For now, Smith reports that her treatments are being covered. And recovering addicts wait for a miracle to save them from their worst nightmare.

Note: EOR reached out to the Department of Behavioral Health, Good Hope Institute, and United Planning Organization requesting comment. None of them have returned our calls or emails.

Candace Y.A. Montague is the health reporter for Capital Community News.


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