INDIANAPOLIS -- A swelling tide of heroin and opioid addictions are prompting the state to soften its ban on new methadone clinics.
A move to allow a handful of new clinics, which lawmakers authorized in part to combat an HIV outbreak tied to opioid abuse, also allows for Medicaid coverage of methadone and other addiction treatments for the first time in years.
The drug is controversial. It’s long been used as an inexpensive, long-term treatment for opioid addiction, but critics say it, too, is addictive. A synthetic form of opium, it is easily abused.
“My concern has been that it gets people off illegal addiction and into legal addiction,” said Senate Public Health Chairman Patricia Miller, R-Indianapolis, a longtime supporter of the ban.
But Miller carried the legislation, effective this month, allowing new methadone treatment programs under strict conditions.
Passed with bipartisan support, the law allows up to five new clinics by 2018. They can only open in communities where the treatment isn’t now offered -- such as rural Scott County, the seat of the HIV outbreak in southern Indiana.
Also, new clinics must be associated with a hospital or community mental health center.
The law allows the state to use federal Medicaid dollars to pay for the methadone treatment - which was illegal until now.
Indiana already has 13 methadone clinics, serving about 14,000 addicts a year, according to state analysts. All but three are for-profit, charging $65 to $100 per week for a course of treatment that involves daily doses.
Three methadone programs operated by community health centers primarily focus on high-risk drug users such as pregnant women or addicts infected with HIV. Federal dollars back those programs, which serve about 1,200 people per year.
Miller's support for a limited expansion of methadone treatment signals a turnabout. In 1998, she was instrumental in passing a law that prohibited any new methadone treatment programs. That followed questions about private, for-profit clinics that sprang up, with little oversight.
Miller fought through the years to preserve the ban, making a rare exception in 2006 for a rural community mental health center in northeast Indiana that wanted to offer methadone treatment to combat rising heroin use.
In this case, Miller said an outbreak of the virus that causes AIDS, which has infected at least 174 people in and around Scott County, forced lawmakers to act. The swell of infections is linked to addicts who share dirty needles to illicitly inject an opioid-based prescription painkiller, Opana.
Prior to the outbreak, few addiction treatment options were available in the community, health officials have acknowledged.
“We’re in the midst of horrible epidemic of drug abuse,” said Miller, a retired public health nurse.
The U.S. Centers for Disease Control and Prevention urges states with high opioid abuse, such as Indiana, to increase access to methadone and other treatments for addicts.
The CDC acknowledges methadone’s potential for abuse and increased risk of overdose. It also cites studies that show methadone can be an effective, long-term replacement for opioids, especially when given as part of a broader treatment strategy.
That’s why addiction experts in Indiana support the idea of putting new methadone programs in hospitals and community mental health centers, where addicts can access other services.
“What we need to have is comprehensive treatment options to get people all the help they need,” said Steve McCaffrey, head of Indiana chapter of Mental Health America.
McCaffery said methadone isn’t a cure-all but an option for those who need more help than an abstinence-based treatment programs.
Under the new law, the state can use Medicaid to cover a range of services and medication aimed at helping addicts become drug-free. That money, for example, can help drug offenders leaving jail or prison combat their addictions.
The change is prompted in part by the Affordable Care Act, which requires states like Indiana to pay for more addiction services under an expanded Medicaid program.
But Miller said the state generally is transforming its approach to addiction, by creating more opportunities for treatment, instead of just locking addicts behind bars.
“I think you’ll see the state much more engaged in treating addiction,” she said.
That’s the hope of Sen. Jim Merritt, R-Indianapolis, who backed Miller’s bill. He’s been pushing for more resources for addiction treatment after seeing heroin use rise in his district.
“Addiction is an illness, not a character flaw,” he said. “We need to put same kind of effort forward to treat it as we do to treat cancer or any other illness.”
Now, under the new law, some community mental health providers are looking at what it will take to begin methadone treatments. The process means clearing many state and federal hurdles.
Centerstone, which provides community-based mental health services in 17 mostly rural counties, is cautiously considering it, said Linda Grove-Paul, vice president for recovery and innovation.
She endorses the idea of broadening treatment options but said “wraparound” services – such as counseling, housing and job training – are critical, too.
“Methadone isn’t a panacea,” she said. “Addicts will need a lot more support than that.”