It is a craving so powerful that addicts will do almost anything to satisfy it.
For thousands of people hooked on heroin and other opiates, a daily swallow of methadone tames the demon and opens the door to a normal life.
But soon the synthetic narcotic, which for decades has been used as a controversial treatment for addiction, no longer may be an option for thousands of Californians.
As part of the effort to dig the state out of its massive budget hole, the Schwarzenegger administration has proposed cutting off Medi-Cal funding for "methadone maintenance" and other treatment programs to most addicts, saving the state $53 million.
Advocates who believe that methadone saves lives and lowers crime committed by society's most hard-core addicts are vigorously protesting the proposed cuts. Today, former federal drug czar Barry McCaffrey and others will try to convince lawmakers that slashing the program would backfire on the state.
"Dumping tens of thousands of opiate addicts back on the street would be an immediate disaster to law enforcement, and to the families of people who have become stable, functioning adults" thanks to methadone, said McCaffrey, who has a consulting firm and serves on the board of directors of an organization that treats chemical dependency.
Dr. John McCarthy, a psychiatrist who has treated opiate addicts for more than three decades, estimated that about 2,000 people are enrolled in methadone maintenance programs in the Sacramento area, and 70 to 80 percent are Medi-Cal patients.
"This is very serious," he said of the proposed cuts. "There is obviously a lot of panic about what we are going to do" if benefits are slashed. "We might be able to cut back on the counseling component of treatment, but we have to find a way to preserve the medication for many patients who are very ill."
Thomas Hicklin, 59, a longtime addict who is stable on methadone, is one of those Medi-Cal patients. Hicklin, who has diabetes and hepatitis C, among other health problems, said he doubts he could afford $300 or more a month for methadone should the cuts take effect.
"It would be devastating to me, and a lot of other addicts who won't get the chance to have a normal life," he said.
The budget proposal calls for eliminating Medi-Cal funding for methadone treatment to everyone except pregnant women and minors. More than 35,000 Californians would be affected, opponents of the cuts estimate. The cuts, effective in October, would mean a loss of more than $60 million in federal funding, they said.
The proposed cuts "are not in any way a statement of the lack of importance" of drug treatment for addicts, said state Finance Department spokesman H.D. Palmer. "They are important. But we've got to focus on closing a $19.1 billion budget gap," and just about everything is on the table, he said.
Methadone is legally prescribed to addicts as a safer substitute for opiates, including heroin and OxyContin. Studies have shown that it helps curb cravings and withdrawal symptoms such as anxiety, nausea and chills without producing an intense "high."
For some, like Amber Castorena, it can provide the control and serenity to lead a normal life.
Castorena, 38, said she lost her job, family and home during more than 20 years of serious drug addiction. She committed crimes to feed her heroin habit, she said. Her singular focus was getting her fix.
"It brings you to your knees," she said of heroin.
Castorena tried inpatient treatment programs, without success, she said. Within a month of starting on methadone more than three years ago, "I was off the streets," Castorena said. "I got my life, my kids, my family back. I do volunteer work, so I'm giving something to society instead of taking."
But methadone maintenance has its skeptics. Some question whether it is wise to allow addicts to substitute one narcotic for another, and believe patients would be better served by programs that focus on weaning them from all drugs.
"My professional opinion is that methadone is good for chronic pain and for detox, but maintenance needs scrutiny," said Dr. Eric Voth, chairman of the Institute on Global Drug Policy.
"The greatest problem I have seen is that addicts shift back and forth from other street drugs to methadone, and nobody holds their feet to the fire to get straight," Voth said. "I think there needs to be rigorous supervision and expectations to accompany methadone's use."
Withdrawal from opiates, said McCarthy, can trigger potentially life-threatening physical and psychiatric symptoms. Addicts suddenly deprived of methadone likely will flood emergency rooms, and ultimately will be tempted to commit crimes or abandon their families to feed their cravings for the drug, he predicted.
Helen Camp, 28, who once was hooked on prescription opiates including Vicodin, said she became a different person when she was chasing her high.
"I had always been the responsible one," she said, but when she became addicted she stole from her family and nearly lost custody of her daughter. Her life is back on track, she said, now that she is in a methadone program.
"It scares me to death to think I might not be able to get it anymore," Camp said. "I don't want to go back to where I was before."
May 26, 2010