One of my 'recoveree's (recovery coaching client), the finance department at his methadone clinic, and I have been battling Affinity Essential Health Care to cover his weekly prescribed methadone. We will call the recoveree Tim for matters of confidentiality. This post is his case study.

Summary:

Tim has been on prescribed methadone from the same doctor at the LESC Chinatown, NYC, NY, for ten years. I started working with him in his 9th year at the LESC Methadone Assisted RecoveryClinic. Tim contacted me when he chose to begin his final taper from 40 mg of methadone/day to abstinence. Tim decided to taper because his insurance company failed to pay for his prescribed methadone.

Tim and his clinician developed a plan to taper. The plan includes: support group meeting attendance, engaging with the recovery community, peer support, trusting the guidance of his supervisor at the Outpatient Treatment Program (OTP) where he is a CASAC II, to journal more often, relax, exercise, and eat healthily. His counselor stressed that Tim learn to trust and engage with his recovery supports several times. At times, Tim feels he can do it all alone. (Old habits die hard!) Tim went a step further and invested in –Arise Recovery Coaching in NYC.

Tim's MAR assessment and substance use Hx –Case Study

Year 1

• Tim enrolls in Methadone Maintenance Treatment Program (MMTP). He reports he is intravenously using 20 to 25 bags of heroin/day, Oxycontin, Roxycontin, and benzodiazepines (Xanax and Klonopin). And $20.00 - $50.00 of cocaine. He has Medicaid and is homeless. Tim has no family support. He came to New York City to get on MMTP because the wait in Upstate, NY, was between 18 - 24 months. When Tim came to NYC, there were only two methadone clinics between Syracuse (45 miles) and Albany (90miles) from where Tim is currently living through any means necessary. He lost his driver's license and didn't have a permanent address.
• Tim didn't understand MMTP, but he believed it would magically take away the need and desire to shoot heroin. He also failed to understand his addiction was deeply-rooted in his past trauma, self-stigma, or self-limiting beliefs. In the first three years, he tests positive for heroin and cocaine on all toxicology screenings. His doses increase from 20 mg to 180 mg daily.

Year 3 - 4.5

• Weekly tox screens results: positive cocaine and benzodiazepines. During this time, Tim's counselor uses harm reduction and educational material to help Tim understand the side-effects of both drugs of choice, dangers, and results when combined with methadone maintenance.
• Tim responds well to friendly conversations that don't include coercion, demands, or ultimatums.

Year 4.5 - 6.0

• Halfway through year 5, Tim's clinician informs him that he has had 21 days of negative toxicology screenings. During this session, a conversation transpired to learn what had changed in Tim's life to distract him from using. He informs his clinician he has started to attend meetings at The Center, an LGBT recovering community.
• He attends several 12-step meetings, even though he feels 12-stepping doesn't work for him. He seeks camaraderie, fellowship, and recovering peers. Tim also attends Refuge and SMART Recovery meetings.
• He seldom associates with 'street junkies,' when he doesn't have, too. After he hustles his money for the day, he spends time at the library, journaling, or going for long walks in Central Park.
• Tim chooses his recovery date. He feels he is working a plan for recovery, changing thoughts, and old behaviors. He still struggles with lapses, but he doesn't follow the path to relapse. Recovery begins. Time stops referring to his program as Methadone Maintenance or his Meth Pg (slang) and starts telling others he is in Methadone Assisted Recovery. He no longer refers to himself or friends as "junkies."

"YOU are in RECOVERY when YOU say you are."

• Over the next 18 months, his toxicology reports continue to show increased lapses of time between substance use occurrences. When toxicology reports test positive, it's for heroin and cocaine; he stopped using benzos.
• His clinician suggests that he consider beginning to taper his methadone dose. He gradually decreases from 180mg to 150 mg. At the end of year 6, Tim celebrated his first year of abstinence.

Year 7

• BRC approaches Tim - Moving Home Program. He moves into an SRO in the Bronx. He now has structure, a place to call his own, and a starting point to find gainful employment. Within the next eight months, Tim is working two delivery jobs and applying for school to become a CASAC.
• Tim's Medicaid will cover him for the remainder of the year. Upon recertification, Tim's income is too high to receive full benefits. He considers quitting one of his two jobs because he fears to lose his methadone.
• Tim doesn't quit either job. He has a plan he and his counselor worker out during individual briefs. He uses his team to work through the fear of not being able to afford MAR. The time comes, and Tim applies for an essential insurance plan. He pays $20.00/month for insurance, which includes a $1.00 copay for prescriptions. His thyroid medication, PReP, and Hep C treatment do not suffer nonpayment.
• Tim finishes the 350 hr CASAC study. He finds a job working outpatient treatment. Tim discloses to his supervisor that he is in Methadone Assisted Recovery. His supervisor says, "So what. Whatever keeps you sober is all that matters to me. FTR: I take a pill each day to keep my blood pressure down. She chuckles and smiles. Her acceptance and approval set Tim's mind at ease.

However, his insurance doesn't cover his prescribed methadone. Stigma resurfaces. He shouldn't have to pay for his methadone, nor should he be scrutinized, stigmatized, and treated as if he is gaming his insurance provider.

Tim expresses the stigma he feels.

• When he submitted his Metro Plus Essential Care Plan card to the finance officer at his Pg, the worker shrugged rolled her eyes, and said, "Oh boy, not again." She explained to him that every ten days, her office would have to prepare an application with reports from the head nurse, the doctor, his counselor, and the finance officer about his progress in treatment. Progress included dosage, toxicology reports, Tx plan, incident reports if applicable, attendance, and a summary of progress from each officer. MetroHealth Plus always found fault with his application, so Tim stopped filing. It was more comfortable, less frustrating, and demoralizing to pay out of pocket. The program offered him a sliding scale; he paid $35.00/week.
• Anger swells inside of Tim. He runs up the stairs, unannounced, and starts yelling at his counselor. He states, "I'm not attempting to get a script of Oxy or Xanny bars. I'm trying to stay sober and live a life in recovery. Why bother when the world sees me fuck a street junkie loser? Fuck it. I'd rather shoot dope then work. I'll quit. Grab my sign and start begging for dope every day. I'll show these fuckers. They're right –Imma no good street junkie with a heart full of napalm. And when I die with a needle in my arm, maybe something will be done to change this fucking system. Fucking worthless. Why do I have to jump through hoops to get my methadone fix? Why?" He turned around and ran back down the stairs and out the door. He left his take homes at the counter.
• Tim's counselor runs down the stairs chasing him. He catches him several blocks away. He convinces Tim to have a cup of coffee and talk. They both come back to the MAR buildings. Tim apologizes. He grabs his take-homes and leaves for work.
• Counselor notes added to the chart concerning "Insurance non-payment –trigger." Work on resolving issues concerning money and anger management. He quotes Tim's anger-fueled outburst the best he can and adds –Tim's language reverts backward. It refects digression too negative self-image and self-talk. Tim hasn't labeled himself with words such as 'Junkie, loser, worthless' in a long time.
• Tim meets three other people at the Pg with the HealthPlus Essential Plan. Each pays out-of-pocket for methadone because insurance refuses to cover Methadone Assisted Recovery.
• End of year 8, Tim is hired full-time working OTP. He quits his two delivery jobs.

Year 9 to present

• Tim is now working full-time and no longer lives in an SRO. He is still eligible for essential plan insurance, so he recently switched to an Affinity Essential Care plan because he was told during a phone interview his MAR would be paid for without an issue.
• Tim pays $40 dollars/month, $1.00/copy. However, Tim's application to have his MAR covered by insurance has not been approved in over eight months. One of Tim's triggers is money. He fears not having money and debt. Tim has several angry outbursts with the financial department over his insurance company not responding to inquiries concerning the payment of his Methadone Assisted Recovery.
• He has now entered his ten years in methadone assisted recovery. He has no positive toxicologies in 5 years. He is now on the Affinity Essential Plan. Affinity continues to scrutinize his past, demand toxicology reports, and other incidental reports if applicable.
• Each week he is handed a bill showing the amount he owes, which has grown exponentially. Tim now longer pays $35.00/week. He pays $55.00 /week. The finance office at his MAR Pg has assured him he will not have to pay this bill at one should his insurance provider deny payment.
• He has also been told many insurance companies only been paying 1/3 to 1/2 of the weekly cost for medicated assisted recovery.
• The finance officers refuse to take payment from him because they know it will be harder to get reimbursed if he were to pay. Tim has not become angry in quite some about paying for his methadone, but he is frustrated. The stigma he feels stagnates him.

The point is why is he paying for it when each day scripts are filled for drugs linked to causing addiction, such as Oxycontin and Xanax covered and medications to help create a path towards recovery NOT COVERED?

• Tim's frustration creates stigma. He feels the only way he can not feel negatively about his pathway for recovery is to taper off methadone completely. He has tried to taper to abstinence several times. He stopped the cycle at 40 mg. Tim asks his counselor for help coming off methadone ultimately. Together they begin to build a network of peers.
• Tim leans into The Center for support. He attends various 12-step meetings, Refuge, and SMART recovery meetings. Tim becomes a member of the SMART community; Tim attends group sessions at The Center when he can. Tim has a reliable network of peers. He also chooses to invest in Recovery Coaching in NYC and calls me.
• When Tim and I began working together, he was on 40 mg /day. He is down to 18mg/day and continues to taper gradually. Unfortunately, self-stigma has resurfaced, but through journaling and conversations, we monitor it, so it doesn't escalate.
• After Tim successfully tapers of methadone, he has chosen to work in Methadone Assisted Recovery, helping others reduce their self-stigma, reduce harmful effects from past trauma, and empower others to believe in themselves and their chosen path for recovery.

To best serve Tim, his clinical support team, sponsor, and I often communicate to stay informed of progress and his growing stress. Through our case management efforts, we have been able to keep abreast of Tim's stigma, frustration, and anger.

End the stigma

Tim's case study and assessment illustrate methadone assisted recovery works. When insurance providers fail, refuse, or deny payment of methadone services, the message sent is negative. Persons who are living their life 'one day at a time' with the assistance of medication battle stigma from every corner. Failure to cover MAR by insurance providers screams ––We Don't Support Your Pathway to Recovery! It creates doubt, anxiety, and fear.

Where would Tim be if he was not afforded the freedom to experience life without the pain, agony, and fear of physical withdrawal?

As a member of Tim's support team, collectively, we fail to see the purpose of the Affinity Essential Plan stigmatization.

We are frustrated with the policies and freedom of insurance providers.

In MAR programs, we stress to our client's methadone is equivalent to taking a pill to combat high blood pressure or the same as a daily shot of insulin.

It is frustrating to see our efforts reduced to ashes by insurance providers, medical professionals, law enforcement agencies, and the public because you choose to hold onto your bias and judgment concerning methadone. The research results are in, and all data points to Methadone Assisted Recovery Works. It's time you got on board, instead of blocking this pathway to recovery.

If you or a loved one are tired of struggling in the throes of addiction to heroin or other drugs ––ARISE Recovery Coaching in NYC can help you NAVIGATE your chaotic lifestyle and find peace and tranquility in a lifestyle set for recovery.

Click here to contact us today.

Attention: Metro Health Plus and Affinity Essential Care Plans, please try to defend your position in the comments below.

#endthestigma #insuranceproviders #methadoneassistedrecovery #harmreduction #methadone #stigma