During the past five years there has been an increasing push for federal, state and local agencies to cut back--sometimes in part, often in total--funding for formerly supported drug programs. The largest of the publicly supported drug abuse programs has been methadone maintenance--a treatment initially heralded as the ultimate cure for heroin addiction. The majority of methadone maintenance patients have counted on public support to pay for their medication, for an open-ended period. Yet both public attitude and budgets have changed regarding methadone maintenance policy. The former has become skeptical, the latter smaller-resulting in numerous proposals and some action that would alter the current methadone maintenance system. As of Oct. 1, 1984, Alameda County (the fifth most populous in California, with a population of 1,145,117 as determined by the 1980 census) will no longer provide funding for individuals who have occupied county-funded methadone maintenance slots for a period of two years or longer. These individuals have the option of transferring to private, paying slots or being detoxified. Three methadone clinics are affected by this new policy, and 300 clients at the outset. This proposal is designed to complete a four year study of 150 of the individuals initially affected by Alameda County's change in policy. The proposed study will follow each of the 150 clients for two and a half years to describe and analyze the impact of the new policy. Using the depth interview and a standardized questionnaire, each client will be interviewed both before s/he is forced to relinquish his/her subsidized slot and thereafter at six month intervals. A total of five follow-up interviews will be completed in addition to the initial interview. The interview will be designed to gather information in the following general areas of the client's life: means of financial support; means of securing drugs (including methadone); drug and alcohol use; physical health status; mental health status; social situation. Completion of the proposed study will allow a unique opportunity to study, on an actual first-hand basis, the implications for a shift in drug treatment policy such as Alameda County's. If, as seems to be the trend, other counties and states are to move in this direction, it is imperative that consequences to clients' lives and public welfare be understood--as this project proposes.
| Rosenbaum, M; Murphy, S; Beck, J (1987) Money for methadone: preliminary findings from a study of Alameda County's new maintenance policy. J Psychoactive Drugs 19:13-9 |
