a bird and a bottle

The High Cost of Drug Treatment
April 17, 2007, 7:41 am
Filed under: blogsturbation, civil rights, drug war, news, NYC, politics

I was a little worried when I saw the headline in today’s NY Times article: Revolving Door for Addicts Adds to Medicaid Cost. Often when I write about my opposition to the drug war, I encourage more widespread use of state-funded treatment programs (though NY is somewhat generous, most states are not). Was this article going to make that argument even less popular than it currently is?

Well, yes and no, and for the most part, the no’s win.

The Times article details the great expense of treating the 500 people in the state who most use and abuse the revolving door of Medicaid-funded treatment in the state. According to the article, those 500 alone cost the system $50 million annually. And that’s certainly a problem, particularly when that money could be spread out to help more people receive badly needed treatment. Those 500 are a drain on resources because they use drug treatment not as a way toward actually kicking their addictions, but rather as a break — a time to lower their resistance so they can get high on a lesser amount of expensive opiates and narcotics, a getaway even. As one former user puts it to the Times:

“I would tell myself I was just a brother who needed a rest, not somebody who had a problem,” he said. “I could mimic what they said with such grace and conviction, they would swear I was cured.”

But while this attitude is part of the reason for the system’s high cost, it’s neither the most central nor the most under state control to change. The real problem, it turns out, is the lack of homeless services which could treat the many needs that drive these 500 – and thousands of others – to seek expensive, inpatient addiction treatment:

The system suits the most frequent patients — most of them homeless, mentally ill, or both — who see the programs as a source of shelter and food. And the most expensive treatment, which usually involves some sedation, can reduce the discomfort of withdrawal better than other methods. […]

But at its core, experts say, the overuse of costly inpatient programs is connected to the lack of housing for homeless people. People are less likely to admit themselves to hospitals, and more likely to adhere to treatment programs, when they are not living on the streets. For more than a decade, the city and state have invested in such housing, including some that accept residents who are not yet drug-free, but demand for housing still far exceeds supply.

Sure, the programs are expensive, but their cost can be controlled not through cutting badly needed treatment services, but through increasing funding for services that meet lower level needs, including temporary housing and food.

Another part of the problem is the structure of federal Medicaid, which in its infinite wisdom, will pay for in-hospital detox (the most expensive) but not inpatient treatment programs, which cost about the same as outpatient medically managed detox (which is explained in the article), and which are more effective long term. It’s a backwards policy that is having a disastrous impact not only on the state’s budget but also on the lives of the many people who could benefit from inpatient, community-based treatment. It seems like a common thread in American social policy, no? Plug a hole with your thumb but don’t figure out what caused the hole or how it might permanently be closed.

Also at LG&M.


4 Comments so far
Leave a comment

This is right on. In a recent New Yorker article, Malcolm Gladwell addressed a similar population and their relation to the ER. A small handful of ER “frequent flyers” cost the State over 100K each – where housing and support services would be much more beneficial for the individual and cost efficient for the State. Gladwell argued that liberals were loathe to reduce human needs to cost efficiency. I think he has an outmoded liberal in mind. Every business knows that sometimes you have to spend money in order to save money. That’s exactly what the State should be doing in this instance. Not in order to pocket more money, but in order to provide better services to more people.

Comment by professorplum

Great points, plum. I think this is exactly the situation where the state (and the federal govt in its medicaid policy) would do well to spend more money on more people in inpatient treatment programs, which may reduce the need for expenditures on hospital detox and will be beneficial more generally.

Comment by bean

Ironically, even the pragmatist Republican Bloomberg is planning substantial increase in assisted living housing in New York. We need to demonstrate that this is a humane and cost-effective solution – so that states that cut off funding prove themselves both ethically and financially below grade.

Comment by professorplum

I realize this is somewhat of a hobbyhorse for me, but American urban policy for the last 50 years or so has pretty much guaranteed that providing more housing to low-income people will be difficult and costly.

The main problem is not citywide; it’s concentrated in a few low-income neighborhoods. I’m fairly certain none of those 500 high-intensity patients lives on the Upper East Side, and that very few if any live in the Village or Chelsea or even Hell’s Kitchen. But instead of helping places like Harlem and the South Bronx help themselves, the city government has addicted them to welfare and charity. It’s smothered the development of any local small businesses. It’s planned housing in a way that destroys rather than builds communities. And it’s tried fixing blight in ways that are closer to McNamara’s concentration camps in Vietnam than to a successful loan program.

Comment by Alon Levy

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