Guest writer Kathleen Kane-Willis, interim director for the Institute for Metropolitan Affairs at Roosevelt University in Chicago, reflects on the ongoing struggle for positive methadone maintenance legislation in Indiana. She discusses the state's historic view of methadone maintenance therapy, current legislative challenges, and what this year's Indiana Bill 0157 means.

Background

Since 1999, the Indiana legislature has passed moratoriums—each year—on new methadone clinics in Indiana.  Until 2006, no new methadone programs could open in a county that had less than 40,000 residents, already had one methadone clinic, or was contiguous to a county that had a methadone clinic.

Why did the legislature enact these series of draconian pieces of legislation?  The reason has to do with Ohio and Kentucky, the states that border Indiana, and the extremely strict laws that govern programs within both those states. As a result of lack of programming in Ohio and Kentucky, more than half of the patients treated in Indiana actually lived in either Ohio or Kentucky (e.g., Illinois has one program to 234,325 residents, while Kentucky has one program to 500,000 residents, and Ohio has one program to one million residents).  Because of the number of patients traveling to Indiana to receive care, Indiana residents and legislators believed—inaccurately—that Indiana’s methadone regulations were particularly lax.

It’s important to remember that because of the methadone moratorium, many clinics have swelled greatly. For example, in southern Indiana, the patient census is around 2,000 and the clinic is overcrowded.  One clinic that borders Ohio is located in a very rural area and the sheer number of patients coming across the state line makes the residents of that county very aware that a methadone program is in operation.

Thus began Indiana’s fierce attack on methadone programs and patients.

In 2006, in no small part due to research by Roosevelt University’s Institute for Metropolitan Affairs, which demonstrated the quickly escalating heroin problem among white youth in northwest Indiana, the state legislature passed legislation that allowed new methadone clinics even if the county adjacent already had a methadone treatment program.  This “reprieve” from the moratorium lasted only one year. In 2007, the Indiana General Assembly passed a full moratorium on all methadone programs, which will expire at the end of this year.   Thankfully, before the new full moratorium passed, two new methadone programs opened in the state, including one nonprofit in Northwestern Indiana to serve the clients who were the focus of our heroin research.

The 2008 Bill

This year, in both the Indiana House and Senate, bills were introduced to strictly curtail methadone operations and to include large fees ($300) for out-of-state patients.  The House version of the bill called for random drug testing and automatic detoxification for any dirty urine tests.  Additionally, the House version called for excluding minors from entering the methadone clinics—even if the parent or guardian was under treatment at the clinic.

The Senate bill took the worst of the language from the House version, namely the automatic detox for any dirty urines in 14 days, and added a designated driver provision.  This version of the bill called for every methadone maintenance therapy patient to have a “designated driver” to take them home from the clinic. 

At this point, we were alerted to the designated driver provision, which the Senate slipped into the bill during a committee hearing.  We decided to take action, working with Indiana methadone providers, the addiction community, the American Society for Addiction Medicine, the American Association for Addiction Medicine, Dr. Robert Newman, director of the International Center for Advancement of Addiction Treatment, and Carmen Arlt, Indiana representative of the National Alliance of Methadone Advocates, who runs the clinic that opened in Northwestern Indiana’s Porter County.  Without the support of these folks, the proposed bill would have been passed for sure!

We worked with the above groups to put together fact sheets for patients and reached out to everyone in the MMT community.  (In fact, a big thanks to Ethan Nadelmann for sending me some important contacts!)

It was touch and go, but we got rid of the two most horrible parts of the proposed legislation:

1)      The designated driver provision, and

2)      The automatic, immediate 14 day detox for any dirty urines (including cannabis)

While it is true that the new legislation calls for a central registry for patients—and I agree that this is not the most ideal situation—I feel that our efforts were a real success.  Getting that 14 day detox out of the act was really important, as were removing the provision that children of patients could not enter the clinic and the designated driver provision—not to mention that we managed to ensure no moratorium for the following year.  Ideally it would be great to not have to have this additional registry, but when you consider the alternative—which could have been really horrific for patients—I think that this bill was a success.  You have to consider the history here and the fervor surrounding MMT programs to really understand how successful, in fact, the bill really was.

That said, anyone who lives in Indiana or would like to work on this issue for the following year—I say this because I know it will be brought up again—should email me and I can put you in touch with Carmen Arlt, the NAMA representative, so that we can gear up for next year.