A decision by the state health department to stop running laboratory tests for Maryland's methadone clinics has removed a primary safeguard against misuse of the drug, potentially worsening what police and health officials say is a growing problem.
Methadone is a heroin replacement medication used by about 13,400 recovering addicts in Maryland. To start on the medication, addicts must go to one of the state's 40 approved clinics. Under federal law, though, clients who have gone through months of daily visits without relapse can earn the opportunity to take home at least some doses.
For at least 20 years, clinics have had one reliable way of making sure take-home doses don't end up being abused for a high by the clients or resold on the street: They have randomly called some clients and ordered them to return their doses within a day.
Because it's not always possible to tell whether the returned bottles holding the syruplike drug have been tampered with, clinics have sent them to a state lab to make sure they match the dosage given to clients. If the lab found a mismatch, as occurred in about 10 percent of the 4,000 samples it checked annually, the client lost his or her take-home privileges.
But last month, clinics received a letter from the Laboratories Administration of the Department of Health and Mental Hygiene stating that because of budget cuts, the state would no longer do the testing.
Clinic directors across the state say the move will make it much harder to ensure that clients are using their take-home doses as directed.
The lab testing "is the only tool we have with which to determine that the people we're giving the bottles to are making responsible use of their medication," said Carol Butler, director of the Reach clinic, which serves 450 clients at a van parked in Baltimore's Barclay neighborhood. "We take our jobs seriously, and we have no other way to enforce to make sure that the people we think are doing well really are."
The move occurs at a time of growing concern about the risks of methadone abuse. Fatal overdoses involving methadone increased five-fold in the state between 1998 and last year, to 124, a rise attributed to the diversion of methadone from clinics and of methadone prescribed as pain medication.
At a meeting last week at Lexington Market, city police and market security personnel told clinic directors that the biggest problem around the market, a focal point of the city's west-side revitalization plans, is the resale of methadone and prescription pills used to enhance methadone's effect. In the past three months, 24 arrests took place outside the market for methadone dealing, police said.
Clinics, which range from 100 to 600 clients, generally offer some take-home privileges to close to half their clients. The idea is to offer an incentive against relapse and make it easier for clients to go to work or care for their families without making daily clinic visits.
The clinics issue random recalls to about 10 percent of these clients every month, directors said, to try to catch those who might have used the doses ahead of the prescribed time or sold them. Clients who fail to return their doses or return an obviously tampered-with bottle lose their privileges.
But sometimes, directors said, clients disguise what they have done. They might refill the plastic bottle with methadone bought on the street or with water colored with food dye, sometimes using a needle to make an undetectable puncture in the container. In those cases, the only way to prove the dose has been tampered with is to have it tested.
"We rely on it completely," said Gary Sweeney, program manager at the Man Alive clinic in Baltimore's Charles North neighborhood.
The director of the Laboratories Administration, John M. DeBoy, said his office has suffered a 2.5 percent budget cut for the fiscal year starting in July and the loss of three or four of its 278 positions. The office conducts hundreds of kinds of tests, for infectious diseases, water contamination and more, and has recently been given new orders involving bioterrorism, food safety and cystic fibrosis. But its staffing is down from 325 employees five years ago, he said.
Faced with the cutbacks, DeBoy said, the office looked to eliminate lab tests that were seen as outside the core public health mission for which the office is funded. It decided, with approval of the health department's leadership, to eliminate the lab position that handled the methadone tests, as well as hematology tests done for local health departments to check for bleeding disorders.
"These are a few of the minor things we had to drop in favor of more major testing," he said. "We'd been doing it for years without [earmarked] funding, so when push came to shove, there was no longer any money to support the program."