Pubdate: Sun, 16 Apr 2006 Source: Roanoke Times (VA) Copyright: 2006 Roanoke Times Contact: http://www.roanoke.com/ Details: http://www.mapinc.org/media/368 Author: Elizabeth Strother Note: Letters from newspaper's circulation area receive publishing priority Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) CLOSING A NEEDED CLINIC DOESN'T MAKE SENSE Why do we tolerate the "war on drugs"? Why don't we fight addiction as the disease that it is? I've wondered that many times over years of writing pleading editorials for more publicly funded substance abuse treatment. Never did the question seem more urgent, though, than when I read in the April 8 Current that the New River Valley Community Services Board in Blacksburg will be shutting down Dr. Martha Wunsch's outpatient addiction clinic June 30. And the reason? Resources, mainly. "It's really, really unfortunate, because it's a wonderful service for the community," she told me last week. The publicly funded Community Services Board still will offer substance abuse treatment, of course. But Wunsch, an addiction medicine specialist, offers a treatment few other physicians are qualified to provide. And through the public agency, she can offer it at a price low-income patients can afford. Wunsch is one of only two doctors in the New River Valley who can prescribe Suboxone to opioid addicts who need the medication to stay clean. Suboxone is itself an opioid that can free addicts of the cravings that drive them to all kinds of antisocial behavior to get their drug, and all kinds of bad behavior while they are high on it. Properly prescribed and taken, Suboxone and methadone, another opioid treatment, do not deliver that destructive high. Wunsch said the Community Services Board is shutting down the clinic for lack of less than $30,000 -- probably closer to $20,000, the amount it pays for her to attend patients there one hour a week. That's not the clinic's full expense, though, the board's executive director, Lynn Chenault, explained in a phone interview. "It's very resource-intensive," he said. "It's not just her time and her work. People who have addictions tend to be very challenging and high maintenance." The agency knew this at the start. Substance abuse services are part of its mission. But, he said, the clinic "is even more demanding on our resources than we thought before we got into it." It takes the work of nurses, case managers, counselors. And the demands on the support staff grew and grew. "It was getting bigger faster than we anticipated," Chenault said. "She developed it faster and to a larger scale than we ever expected it to be." And the clinic didn't find any new revenues to offset any of the added costs. When a new medical director came on board in January, he recommended phasing it out. The flip side of that coin, however, is this: The high demand is evidence of a community need. And the public agency's staff support is what has made the clinic affordable for many people who need it. "At the CSB, there's counselors, there's case managers," Wunsch lamented, unknowingly echoing Chenault's concerns. "This agency is the perfect place to provide these people with these services. ... From a public health perspective, this clinic was brilliant." Wunsch is working to establish a privately owned addiction treatment clinic in Blacksburg, and she runs a small private practice in addition to being an associate professor at the Edward Via Virginia College of Osteopathic Medicine at Virginia Tech. "In a private practice, I will find funding," she noted wryly. "It's called, the patients will pay for it." If they cannot, and public funding remains lacking, the community will pay in worse ways: crime, for one, with its attendant costs for jails and police, to say nothing of the losses to victims and the sense of community well-being. "In this area, given the [clinic] waiting list, we probably have at least 1,000 people in need of services," Wunsch said. Chenault agreed there is a huge and growing gap between need and services, and that opioid treatment is one of the services needed. In his 22 years as head of the NRV Community Services Board, he said, there has been an "extreme, dramatically striking" change in the level of public support. At the start of his tenure, the agency depended on patient fees for 17 percent to 18 percent of its income. "Now that is two-thirds." "This mandate of CSBs that we don't deny services to people just because they can't pay -- that's harder and harder and harder to do." Putting more and more people in prisons, though? That is easy. So back to my question. Why do we, as a society, not spend more on treatment? It's cheaper. And the savings include lives. - --- MAP posted-by: Larry Seguin