Venture capital and methadone

postcard---heroin-lie

There must be a lot of money available if private equity firms are willing to expose themselves to this much risk:

At least five state legislatures are considering bills to tighten oversight of methadone clinics after allegations that take-home doses of the drug are contributing to illegal street sales, misuse and deaths.

Measures in West Virginia, Minnesota, Indiana, Pennsylvania and Maine, if passed, could increase costs or limit revenue for the nation’s largest methadone chains — both of them backed by private equity firms: CRC Health Corp. is owned by Boston-based Bain Capital Partners LLC; and Colonial Management Group LP is in the portfolio of Warwick Group Inc. of New Canaan, Connecticut.

Police, prosecutors and state regulators have linked clinics operated by CRC and Colonial to doses of the synthetic narcotic that were diverted into black-market sales — sometimes with deadly results.

Police, prosecutors and state regulators have linked clinics operated by CRC and Colonial to doses of the synthetic narcotic that were diverted into black-market sales — sometimes with deadly results.

The array of legislation reflects concerns that some for- profit clinics — which distribute the synthetic narcotic to help patients beat addictions to heroin and other opiates — don’t provide enough services, said Robert Lubran, director of pharmacologic therapies at the U.S. Substance Abuse and Mental Health Services Administration.

“We know for-profit providers often provide a lower level of service” than non-profit counterparts, Lubran said.

“It’s a question across the nation: Is it a cash cow these providers are running or are they really trying to help our citizens?” said Meshea Poore, a Democratic member of West Virginia’s House of Delegates.

Balancing pain management and public health

Advertisement for curing morphine addictions f...
Advertisement for curing morphine addictions from Overland Monthly, January 1900 (Photo credit: Wikipedia)

I blogged before about the availability of opiates for pain management and the need to try to limit their diversion. While others have complained about draconian limitations on the prescribing of opiates and being too afraid to treat pain, I pointed out the explosion in opiate prescriptions and overdoses. It’s a complex problem that demands a solution that balances the needs of pain patients with the public health risks of easily available opiates.

Here’s a new study looking at the issue [emphasis mine]:

While overdose death rates related to heroin, cocaine, sedative hypnotics, and psychostimulants increased between 1999 and 2009, deaths related to pharmaceutical opioids increased most dramatically, nearly 4-fold. In 2000, the Joint Commission on the Accreditation of Health Care Organizations introduced new standards for pain management which focused on increased awareness of patient’s right to pain relief which contributed to an increase in prescribing of opioid analgesics (Phillips, 2000 and Federation of State Medical Boards of the US, 1998). The average milligrams of morphine prescribed per patient per year increased more than 600% from 1997 to 2007, which led to an increased availability of pharmaceutical opioids for illicit use (US Department of Justice, 2012). From 1999 to 2007, substance abuse treatment admissions for pharmaceutical opioid abuse increased nearly 4-fold and emergency department visit rates related to pharmaceutical opioids increased 111% from 2004 to 2008; visit rates were highest for oxycodone, hydrocodone, and methadone (SAMHSA, 2009aSAMHSA, 2009b and SAMHSA, 2011). Risks associated with pharmaceutical opioid related overdose included taking high daily doses of opioids and seeking care from multiple healthcare providers to obtain many prescriptions (Paulozzi et al., 2012 and Hall et al., 2008). “Doctor shopping” has also been associated with opioid diversion and illicit use (SAMHSA, 2010 and Rigg et al., 2012). National survey data showed that 75% of pharmaceutical opioid users were using opioids prescribed to someone else (Substance Abuse and Mental Health Services Administration, 2010).