I Used to Be a Heroin Addict; Now I'm a Methadone Addict
There's a solid piece at Wired News about Buprenorphine, a treatment for heroin that kills withdrawal symptoms quickly, but without the abuse potential of methadone. Unfortunately, it hasn't taken off as expected, in part because of some ill-conceived regulation:
After bupe had been on the market a year, the law was amended to permit methadone clinics to prescribe it, but only under the same rules used for methadone (one dose per visit), which erases one of bupe's major advantages - that you don't have to schlep to a clinic every day. Meanwhile, many methadone providers have remained openly skeptical of the new med, fearing that it will further stigmatize methadone, or siphon off their most stable patients. The government reimburses methadone programs for the number of patients they oversee, not for the specific services they provide, so the payment for a stable patient who takes a dose and goes to work subsidizes treatment for more fragile clients with multiple addictions, mental illness, housing and unemployment issues, and more.
The regulatory problems didn't stop there. Influenced by tales of unscrupulous methadone clinics taking on huge case-loads for the reimbursement cash, Congress barred doctors from maintaining more than 30 bupe patients at a time. And in a monumental blunder, the law classified giant HMOs like Kaiser Permanente, as well as hospitals, as single providers, with the same 30-patient cap that Kolodny has in the solo practice he maintains on evenings and weekends. Four years later, the law remains unchanged. One clear sign of the law's unintended consequences: The world-renowned Addiction Institute of New York (better recognized by its old name, Smithers) doesn't mention bupe in its advertising because with a 30-patient limit, it fears it would have to turn people away.
