Kurt Wagner was 12-years clean when his life began to unravel. He lost his job, his wife left and the money ran out. Homeless and alone, the uninsured Wagner had to pay $300 a month for methadone treatment. When he could no longer afford it, it was only a matter of time before he fell off the wagon.
“I couldn’t keep up with the payments, so they feetoxed me,” said the 58-year-old Wagner. He explains while seated outside CRC Health Group in south Sacramento this past Thursday that “feetox” refers to the process methadone clinics undertake for patients who run out of money. They wean them off treatment over two to three weeks to minimize the inevitable shock of withdrawal.
This was when Wagner turned to heroin for the first time in more than a decade.
And this was how he lived for years after: on and off of methadone, then relapsing whenever money for treatment ran out. It wasn’t until three months ago, when he joined the millions of Californians who have signed up for Medi-Cal since last year, that Wagner was able to clean up for good.
He is among 7,774 Californians taking advantage of addiction services newly available to them thanks to the expanded coverage and services mandated under the Affordable Care Act. Since the law’s January 1 inception, methadone clinics across the Sacramento region have noted an increase in care provided. And they’re encouraged.
“We certainly have seen a small spike,” said Garrett Stenson, program director of downtown Sacramento’s CORE Medical Clinic Inc. “And then we’ve also seen people that didn’t have insurance that were struggling to pay for the program get insurance and stabilize.”
Stenson estimates a 5 to 7 percent increase in visitors to his clinic since the year began, thanks largely to patients gaining coverage with Medi-Cal, the state’s iteration of the federal Medicaid program that provides coverage for low-income Americans.
Under the ACA, states have the option to expand Medicaid coverage to include residents at 133 percent of the poverty level (for instance, a family of three earning around $27,000 per year). California is among the 26 states, as well as Washington, D.C., to opt into expansion.
Some 1.9 million Californians have enrolled for Medi-Cal benefits since October 1, 2013, according to Carol Sloan of the California Department of Health Care Services. While numbers on who among them were newly eligible under ACA won’t be available until next month, the expansion has opened a path for low-wage earners seeking to escape heroin addiction in the midst of what law-enforcement agencies are now calling an epidemic.
According to DHCS, Sacramento County saw 1,062 admissions to treatment for heroin addiction in fiscal year 2012-2013, a staggering 33.4 percent increase from the year before. Heroin accounted for 17.1 percent of the county’s treatment admissions, a higher share than the previous six years of data provided by DHCS. Almost one-fifth of the 175,000 treatment admissions across California last year were heroin addicts.
Heroin addiction has risen as abuse of prescription opiates like OxyContin and Vicodin went up in the last decade, with heroin serving as an economical substitute to painkillers. Addiction experts claim the correlation is significant. Government data shows some 620,000 Americans recently reported using heroin in the past 12 months—almost twice the respondents in 2007.
Given such unsettling numbers, can increased access to methadone treatment through Medi-Cal really make a difference?
Methadone is a tried and true deterrent to opiate addiction. The California Society of Addiction Medicine says methadone treatment is associated with success rates between 60 and 90 percent, compared to 5 to 10 percent rates with drug-free treatments. Beyond that, the National Institutes of Health says that treatment is a sound societal investment, estimating that every dollar spent on treatment will save the community $4-$7 in justice system and drug-related crime costs.
“I think it’s all positive for people who don’t have any money,” Wagner says. Now three months sober, he says the next step is to find work.