October 2013
Executive
Summary
Methadone
is an inexpensive medication approved by the U.S. Food and Drug Administration
for the treatment of heroin and other opioid dependence. Studies indicate that
methadone reduces relapse, emergency department visits and hospital admissions.
In general, the stability methadone provides helps patients better manage their
overall health.
Including
methadone treatment in Illinois’ State Medicaid Plan will reduce healthcare
costs and help the state address the growing epidemic of opioid dependence.
Patients can only access methadone treatment for their opioid dependence
through the highly regulated Opioid Treatment Program (OTP) system. The system
requires programs be registered with the Drug Enforcement Administration,
certified by the federal Health and Human Services’ Center for Substance Abuse
Treatment and licensed by the Illinois Department of Human Services’ Division
of Alcoholism and Substance Abuse.
OTPs
utilize a multidisciplinary team comprised of physicians, nurses, and
counselors to address the bio-psycho-social needs of each individual patient.
This holistic approach to treatment has been in place in OTPs for more than 40
years, long before most other systems embraced the health home model. The
strong positive relationships between patients and professionals in OTPs helps
patients feel empowered to address their own health needs.
Numerous
studies have documented the cost savings generated by stabilizing opioid
dependent individuals on methadone and helping them manage their comorbid
conditions. Emergency department visits and hospital admissions are
significantly reduced because patient health is carefully monitored and
addressed. In spite of medical evidence documenting the effectiveness of
methadone treatment and the cost savings achieved, some health plans have
excluded this treatment modality. Patient advocates have suggested this is
largely due to the stigma related to heroin addiction.
Untreated
opioid dependence in Illinois leads to unnecessary emergency department visits
and hospital admissions. Some of these visits are due to drug overdoses or
attempts to seek treatment for withdrawal symptoms. However, others are due to
the multiple unmanaged comorbid conditions, such as diabetes and hypertension,
which are highly prevalent in opioid dependent individuals.
Illinois’ administrative leadership has demonstrated its
commitment to resolving Illinois’ fiscal crisis. The cost savings achieved by
covering methadone treatment in Illinois’ State Medicaid Plan can be part of
this solution. In addition to saving taxpayer dollars in unnecessary
hospitalizations, providing increased access to treatment aligns with three
core objectives of Illinois’ Budgeting for Results initiative: 1) to improve
the overall health of Illinois residents; 2) to meet the needs /improve the
quality of life for the most vulnerable persons; and 3) to increase individual
and family self-sufficiency.
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