Methadone maintenance is supposed to bring long-term stability to heroin addicts’ lives. But more than 300 methadone clients in a D.C. program could have their treatment disrupted next week, with little or no notice.
The Comprehensive Methadone Program at 33 N St. NE, run by the United Planning Organization (UPO) under contract with the D.C. Addiction Prevention and Recovery Administration (APRA), may close its doors, says UPO Executive Director Benjamin Jennings. Last week, UPO informed the 16-member staff at the N Street clinic that some of them will be cleaning out their offices on March 27.
The UPO clinic is one of four methadone-treatment programs funded by APRA, and it serves some 312 clients. Many patients come to N Street for treatment and counseling every day.
William Steward, D.C. Department of Health’s interim senior deputy director of substance abuse services, says he is determined not to let the UPO program close. “We’re going to do what we need to on this end to make sure that doesn’t happen,” he says.
But Jennings says the N Street site is feeling the impact of District budget cuts and the Choice in Drug Treatment Act of 2000. The law, which took effect this fiscal year, changes the way APRA pays for drug-treatment services. In the past, the District paid up front for services, whether they were delivered or not. Under the new system, the District pays only for services that have been given.
Under the new APRA funding rules, Jennings estimates that the N Street clinic will have to get by with $300,000 less until the end of the fiscal year. Jennings says that the cuts would force the remaining staff to double caseloads, putting the clinic out of compliance with District and federal requirements that include a patient-to-staff ratio of 40 to 1. “I can’t afford to be out of compliance,” Jennings says. As a result, he says, he is considering pulling the UPO out of methadone treatment altogether.
Steward concedes that the new payment arrangement can create problems for small providers, who are less able to weather financial fluctuations. But because of District budget cuts, APRA doesn’t have the funds to soften the blow for the UPO. Steward says the Choice in Drug Treatment Act required that APRA spend $2 million to implement programs for youth. In order to do so, Steward says, APRA has had to divert the money from adult services. “We had to shift some things around,” he says.
APRA’s budget woes may not even be over yet. The amount of the cut APRA will have to absorb “is still being determined,” Steward says.
“There are going to be changes,” he says. But he insists that they won’t result in any disruptions in service. Steward says that APRA is trying to avoid driving up the UPO’s caseloads by reducing the number of clients served at N Street. He says clients who can no longer be served at 33 N St. will be sent to the Model Treatment Program, a city-run methadone program nearby at 1300 First St. NE, which serves more than 400.
But APRA estimates that only 60 people will have to be transferred from the UPO clinic to 1300 First St. Jennings says the number could be far higher; with less funding, he argues, the UPO won’t be able to serve as many clients as APRA is expecting it to.
One longtime N Street client who asked to not be identified complains that clients have not been officially briefed about any upcoming changes. “They haven’t said anything yet, and [the layoffs] are nine days away,” she says.
Steward says it is up to contractors to inform their clients. He says APRA has held meetings for clients at the city-run methadone programs. “I understand clients get upset when there’s any change in their treatment regimen, but we are giving them notification, and we are talking to UPO about options,” he says. “The end result is everybody will be served.”
The N Street patient worries that even if service continues, the quality won’t be the same without counseling. “It will affect the clients 100 percent if they turn this place into a gas-and-go,” she says. “We rely on our counselors and the ability to contact them when necessary. We have our life monitored in a sense. It’s not going to work without them.” CP