The fourth and last in a series by Cliff Lewis

NewsLanc recently interviewed Rick Kastner, Executive Director of the Lancaster County Drug and Alcohol Commission (LCDAC). The LCDAC exists to “provide high quality prevention/education programs and treatment services for uninsured and low income citizens.” Our discussion with Kastner revealed the many challenges facing both Lancaster’s drug and alcohol addicted residents and the systems that seek to help them.

With the current state of the economy and its impact on State and Federal budgets, Kastner recently noticed a lot of discussion from other government agencies about funding cuts. This led him to take a look back at the LCDAC’s allocations from previous years. “As I suspected,” Kastner said, “we actually were being cut for the last seven or eight years.”

Below are the annual allocations received by the LCDAC since 2002. This list does not account for inflation:

2002-2003 $3,803,816
2003-2004 $3,707,901
2004-2005 $3,776,497
2005-2006 $3,637,925
2006-2007 $3,637,925
2007-2008 $3,592,948
2008-2009 $3,554,089

These allocations are unusually low compared to other government funded human services, which, according to Kastner, typically receive around $10 million each year. As reported by NewsLanc in earlier portions of this series, the demand for the LCDAC’s services has only risen in recent years-despite this drop in support.

The people who rely on the LCDAC for rehab services are those “working poor” individuals who make too little to afford health care, and make too much to qualify for medical assistance (MA): They are stuck in the middle. But with a perpetually shrinking budget, the LCDAC has been unable to fully satisfy this growing need.

One way that the LCDAC has sought to help the working poor, in spite of limited funding, is to actually assist these individuals in applying for MA, which could effectively provide uncapped rehab assistance. Many of these cases, however, are a sad compromise, as Kastner elaborates: “So we can continue serving people essentially if they loose everything and they get on the welfare card. Which is not the incentive we want.”

Through the course of this series, we have seen how recent LCDAC under-funding has shortchanged Lancaster’s working poor; we have seen that much of this under-funding derives from an imbalanced emphasis on drug law enforcement and interdiction; and we have seen how successful rehab treatment in Lancaster County has, ironically, come to push even greater demand onto the LCDAC’s under-funded services. But a look at past budget allocations reveals that the pinch in resources has little to do with the current state of the economy.

For Kastner, this kind of under-funding has long been an unfortunate fact of life: “The cuts that are getting a lot of attention these days, and the shortfalls in State and Federal budgets are new to some other programs or systems, but is not new with the drug and alcohol field.”

The third in a series

NewsLanc recently interviewed Rick Kastner, Executive Director of the Lancaster County Drug and Alcohol Commission (LCDAC). The LCDAC exists to “provide high quality prevention/education programs and treatment services for uninsured and low income citizens.” Our discussion with Kastner revealed the many challenges facing both Lancaster’s drug and alcohol addicted residents and the systems that seek to help them.

Surprisingly, the 2006 opening of a Lancaster-based methadone clinic has increased the demand for similar treatment services from the LCDAC.

In the time since the clinic opened, the number of county residents under methadone or Suboxone treatment has increased from mere dozens to nearly 300. Also during this time, the LCDAC has had to carve funding out of its rehab budget to support the rising demand for these treatments among its “working poor” patrons. According to Kastner, this trend is actually a testament to the success of the clinic’s program.

As Kastner explained it, the demand has risen because many individuals enter methadone or Suboxone treatment under public medical assistance. As the treatment settles these individuals into a stable rhythm of life, they often begin working a steady job. This can potentially push them out of medical assistance and into that “working poor” demographic that the LCDAC primarily serves.

Kastner estimates that, out of the 5,000 to 10,000 heroin addicts currently living in Lancaster County, only about 150 of them are under Suboxone treatment. Furthermore, shortfalls in funding are only one reason why this type of addiction management is not helping as many local residents as it could.

Suboxone is an addiction management medication that, unlike methadone, the FDA has approved for at home use under a doctor’s prescription. Because this new and advanced medication remains patented by its manufacturer, there exist no generic alternatives on the market at this time. For this reason, Suboxone is considerably more expensive and thus less accessible than methadone.

Another reason that Kastner cites for why Suboxone is not in greater use is that there are only 15 doctors in Lancaster care to be licensed to prescribe it:

“A lot of physicians really don’t want to be trained in the use of Suboxone and have a caseload of heroin addicts. And you don’t make much money by treating people on suboxone-you’d probably make a lot more money taking care of peoples’ ingrown toenails.”

The second in a series by Cliff Lewis

NewsLanc recently interviewed Rick Kastner, Executive Director of the Lancaster County Drug and Alcohol Commission (LCDAC). The LCDAC exists to “provide high quality prevention/education programs and treatment services for uninsured and low income citizens.” Our discussion with Kastner revealed the many challenges facing both Lancaster’s drug and alcohol addicted residents and the systems that seek to help them.

Most Federal and State funded programs have encountered budget cuts as a result of the recent economic recession. But, according to Kastner, this is no new development for the LCDAC. Whereas most other government funded human services programs are budgeted around $10 million each year, the LCDAC has received less than $4 million for each of the past seven years.

When asked by NewsLanc what may be the cause of this persistent shortfall, Kastner replied without hesitation:

“The drug and alcohol field has always received a lot of attention with enforcement and interdiction. Enforcement with tens of billions of dollars in the country going towards law enforcement to basically bust the addicts and alcoholics, and interdiction to keep it out of the country, or to keep it from being manufactured and distributed. But treatment and prevention has always received, by far, a minuscule amount of funding compared to enforcement and interdiction.”

In fact, the ratio of funding for enforcement/interdiction compared to treatment/prevention is at least 100 to 1, in Kastner’s estimate. Considering research demonstrating that every dollar put into treatment/prevention saves at least seven dollars in other social costs (prisons, mental health, hospital beds, etc.), Kastner asserted, “It’s very frustrating when you see the results of our treatment and prevention programs, but then you don’t have the public dollars to help those people who are working yet don’t have the insurance to cover their drug and alcohol treatment.”

Kastner hopes that one positive change could occur if the Obama Administration comes up with a plan for affordable health care for all. If the plan were to include adequate provision for addiction services, this could largely correct the funding problem. In this case, the “working poor” could receive care through their own health insurance coverage, and the LCDAC would no longer be needed to fund treatment programs at all.

Kastner would be happy to direct LCDAC funds away from treatment, as long as the people are served through other means. “I would like to be able to focus most of our attention on our prevention programs,” He noted, “My funding is small, but we could a lot with that $3.5 million if we could put it all in prevention and education—and probably decrease the demand for treatment services.”

The first in a series by Cliff Lewis

NewsLanc recently interviewed Rick Kastner, Executive Director of the Lancaster County Drug and Alcohol Commission (LCDAC). The LCDAC exists to “provide high quality prevention/education programs and treatment services for uninsured and low income citizens.” Our discussion with Kastner revealed the many challenges facing both Lancaster’s drug and alcohol addicted residents and the systems that seek to help them.

On December 8, 2008, the Lancaster County Drug and Alcohol Commission (LCDAC) had to cease accepting new placements into rehab and halfway house (HH) programs. There will be no new admissions until the beginning of the next fiscal year, on July 1. Of course, the LCDAC, which has historically received scanty funding from its State and Federal sources, has had to block admission to these programs before—but only for about two months, not seven.

Detox treatments (often dealing with life-or-death situations) and outpatient treatment (often less expensive) have remained open for new admissions. But rehab and HH are generally considered the “bread and butter” of addiction treatment, and their temporary closing marks a severe reduction in LCDAC’s treatment services.

On July 1, when the LCDAC receives its new budget, the rehab and HH admissions will be reopened. But not for long. This next budget will likely be cut by at least 2%, but probably more. In the words of Kastner, “It’ll be a real victory if we only have that 2% cut.”

The actual rehab and HH facilities are still up and running, because people are also admitted through personal health insurance or public medical assistance: “The welfare card in Lancaster provides over $6 million in [drug and alcohol] treatment….So our office is not the only referral source in town to keep those beds filled.”

Unfortunately, there is one class of people that will not be offered many of those beds in the coming months: The “working poor.” This group includes those workers who do not qualify for public medical assistance, yet cannot afford the cost of health care. Those who can barely afford health care can rarely obtain a plan that would cover drug and alcohol treatment. The LCDAC would typically provide rehab or HH services to people in such circumstances, were it not for the current budget limitations.

When asked by NewsLanc whether a lengthy waiting list has been accrued for rehab and HH since December, Kastner replied candidly, “We don’t keep waiting lists because an addict doesn’t stay put long enough to really make a waiting list worthwhile…. Let’s say you want to buy a brand new car, and there’s a waiting list, like early on with some of the hybrids. When they call you at home, you’re probably going to answer the phone and say ‘Yeah, I still want the car’—at least most people would. With a heroin addict, or any addict,…they don’t sit put very long.”