March 2007

Grant Results

SUMMARY

Researchers at the Oregon Health and Science University's Department of Public Health and Preventive Medicine studied the impact on clients enrolled in methadone maintenance services in Oregon when the state eliminated funding for their treatment in March 2003.

Key Findings

  • The majority (68 percent) of those who lost state-paid methadone services chose to pay for treatment on their own.
  • Of those who began to pay for their own methadone treatment, 66 percent were able to continue paying for the full year.
  • Some 19 percent of those who attempted to self-pay eventually detoxed from methadone and an additional 15 percent abruptly stopped methadone, indicating that they may have returned to using heroin.
  • Patients who were forced off methadone tended to have more medical, employment, psychiatric, drug and legal problems than the group that paid for methadone services and the group that retained the benefit.

Key Conclusions

  • "These results indicate that cutting benefits across the board is more likely to have detrimental effects for those most in need," the researchers concluded.

Funding
Three phases of this research were funded respectively by:

  • Oregon Practice Improvement Collaborative ($10,000)
  • Robert Wood Johnson Foundation (RWJF) ($19,756)
  • National Institute of Drug Addiction as part of the B/START (Behavioral Science Track Award for Rapid Transition) Initiative ($50,000).

 See Grant Detail & Contact Information
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THE PROBLEM

Methadone maintenance treatment is the most widely used pharmacological treatment for people who suffer dependence on heroin and other opiates. Prior research suggests that individuals who cannot continue methadone maintenance resume the use of heroin and may suffer increased medical, legal, family, employment and psychiatric problems. No prior studies have prospectively evaluated the short- and long-term effects of losing access to methadone treatment.

The Oregon Health Plan (the state's Medicaid program) has two levels of benefits. The Oregon Health Plan Plus provides full coverage for individuals who meet federal eligibility requirements, and the Oregon Health Plan Standard provides coverage at a reduced level for individuals at higher income levels. In March 2003, Oregon eliminated outpatient substance abuse treatment and mental health services for Oregon Health Plan Standard beneficiaries to help offset the state's budget deficit. Some 3,000 beneficiaries lost coverage for methadone treatment as a result, while 2,000 Oregon Health Plan Plus beneficiaries retained coverage for methadone treatment.

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THE PROJECT

The researchers collaborated with the Oregon Office of Mental Health and Addiction Services, the Oregon Medical Assistance Program (Medicaid), and CODA (a not-for-profit substance abuse treatment program in Portland) to monitor the outcomes of Oregon Health Plan Standard clients who lost coverage for methadone maintenance and to compare their experiences to those of Oregon Health Plan Plus patients who retained the benefit. Three groups of clients were selected to participate in the study:

  • Those forced off methadone.
  • Those who sought to pay for methadone treatment themselves.
  • Those who retained their methadone benefit.

Beginning with a $10,000 grant from the Oregon Practice Improvement Collaborative, the researchers recruited 150 clients from CODA in late February and early March of 2003 and conducted interviews using three standard assessment instruments:

  • The Addiction Severity Index, which assesses seven potential problem areas in substance-abusing patients: medical status, employment and support, drug use, alcohol use, legal status, family/social status and psychiatric status.
  • The Treatment Services Review, which asks about the use of specific services provided to patients receiving substance abuse and other treatment.
  • The HIV Risk Behavior Survey, used to measure HIV risk behaviors (i.e., unprotected sex and needle reuse).

The researchers conducted follow-up interviews with 130 of these subjects in April 2003. In order to retain study participants, the researchers offered clients gift cards to a local grocery store for each completed interview.

With RWJF funding, the researchers:

  1. Conducted a third round of interviews in June 2003 with 122 out of the original sample of 150 clients.
  2. Examined treatment records for all 150 clients, including methadone dosing information, length of treatment, psychiatric status and diagnosis, physical and medical problems, and urinalysis.
  3. Developed a database for the study.

With a $50,000 grant from the National Institute on Drug Abuse's B/START (Behavioral Science Track Award for Rapid Transition) Initiative, researchers conducted one-year follow-up interviews with 114 study participants in February–March 2004. The researchers also obtained information on study participants from various Oregon State databases including law enforcement, employment, Medicaid and a substance abuse services database.

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FINDINGS

The researchers reported the following findings in a paper currently under review, "Elimination of Methadone Benefits in the Oregon Health Plan: Patient Impacts":

  • The majority (68 percent) of those who lost state-paid methadone services chose to pay for treatment on their own. The self-paying patients were more likely to be employed and better off financially, medically and psychologically than those who could not pay for their methadone.
  • Of those who began to pay for their own methadone treatment, 66 percent were able to continue paying for the full year.
  • Among all those who were forced off state-financed methadone, 45 percent continued treatment.
  • 19 percent of those who attempted to self-pay eventually detoxed from methadone and an additional 15 percent abruptly stopped methadone, indicating that they may have returned to using heroin.
  • Patients who were forced off methadone tended to have more medical, employment, psychiatric, drug and legal problems than the group that paid for methadone services and the group that retained the benefit.
  • Those forced off methadone were more likely to use heroin both during their detox period and over the following year, and less likely to be in any form of treatment, than the groups that maintained methadone treatment.

"These results indicate that cutting benefits across the board is more likely to have detrimental effects for those most in need," the researchers concluded.

Limitations

The researchers noted the following limitation to the findings:

  • Oregon Health Plan (OHP) Standard and Plus beneficiaries differ in several ways: Plus patients are more likely to be women, disabled, and poorer; Standard patients are more likely to be men, and to have greater socioeconomic resources. These differences may have affected the comparisons made in the study between OHP-Standard and OHP-Plus patients.
  • The sample size was small, and attrition in later interviews was higher in the group that lost coverage than in the group that retained it.

Communications

The researchers have written a paper, "Elimination of Methadone Benefits in the Oregon Health Plan and its Effects on Patients," reporting their findings, and it has been published in Psychiatric Services. (See the Bibliography for details.) Brent E. Fuller, Ph.D., the principal investigator, presented findings from the research at the Addiction Health Services Research Conference, held October 7, 2004, in Philadelphia.

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LESSONS LEARNED

  1. Offer incentives for completed interviews. Clients were provided with a grocery store gift card for each interview and a bonus gift card if the client completed all four interviews. This helped retain study participants throughout the study. (Principal Investigator)

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AFTER THE GRANT

A paper examining state records on the 150 participants is currently in production.

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GRANT DETAILS & CONTACT INFORMATION

Project

Assessing the Impact of a Change to the Oregon Health Plan's Coverage of Substance Abuse Treatment

Grantee

Oregon Health and Science University Department of Public Health and Preventive Medicine (Portland,  OR)

  • Amount: $ 19,756
    Dates: April 2003 to October 2003
    ID#:  048301

Contact

Bret E. Fuller, Ph.D.
(503) 494-6553
fullerb@ohsu.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Fuller BE, Rieckmann T, McCarty DJ, Ringor-Carty R and Kennard S. "Elimination of Methadone Benefits in the Oregon Health Plan and Its Effects on Patients," Psychiatric Services, 57: 686–691, 2006. Abstract available online.

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Report prepared by: Barbara Matacera Barr
Reviewed by: Robert Narus
Reviewed by: Molly McKaughan
Program Officer: Lori A. Melichar
Program Officer: Victor A. Capoccia