Budget cuts put federal drug abuse aid at risk

With New England in the midst of an epidemic of heroin use, Massachusetts is on the verge of forfeiting more than $9 million in federal aid for treating drug users, a penalty for three years of reductions in state spending on substance abuse services.

Since the 2001 budget year, the state Department of Public Health has cut nearly $11 million from what it devotes to treating drug users and preventing narcotic and alcohol abuse. Governor Mitt Romney is proposing $2 million in additional reductions for the next budget year, although a representative of the governor said those cuts would not imperil essential services.

Executives who run treatment centers and health care advocates said that the Department of Public Health cuts in combination with reductions in other state programs, particularly the MassHealth Basic insurance plan for the poor, have already spawned deep reductions in services.

Among the most graphic examples: The number of treatment beds dedicated to substance users needing urgent detoxification has plummeted from nearly 1,000 statewide a year ago to just 420 now, meaning patients wait weeks or even months for a slot.

States that receive grants from the US Substance Abuse and Mental Health Services Administration pledge to maintain fairly constant levels of financial support for substance abuse programs. Because Massachusetts has not, the federal agency notified the state late last year that it is in violation of the grant program's rules and that, under a complex formula, it will lose $9.2 million from the $34.3 million it was poised to receive for the coming budget year.

The consequences of such a loss -- which would amount to 13 percent of the total substance abuse budget in the Department of Public Health -- would prove devastating, treatment center executives warn. It would occur as the region struggles with an unparalleled surge in heroin use and deaths related to that drug and other opioids, including the prescription painkiller OxyContin.

Accidental overdose deaths of Massachusetts residents attributed to opioid use soared from 94 in 1990 to 487 in 2001, the latest year for which figures are available from the department.

"The potential loss of another $9 million in substance abuse funding would be disastrous to the Commonwealth," said John Auerbach, executive director of the Boston Public Health Commission. "Our treatment and prevention efforts have already been significantly crippled and the prospect of facing millions of dollars of additional cuts would bring our substance abuse system to its knees."

Federal authorities, who last month denied an appeal from the state, acknowledge that the reduction would harm users desperate for help. But in both a letter to the state that was obtained by the Globe and in an interview, representatives from the substance abuse agency said they had little choice.

"As much as it may pain us to do this, it's the law, and we'll be carrying it out," said Mark Weber, spokesman for the federal agency.

State public health authorities are making a last-ditch appeal to their federal counterparts, Department of Public Health spokeswoman Roseanne Pawelec said. "The governor is relying on us to make the state's case that we've done a good job of maintaining core services and maintaining access to services despite a budget situation that mandated reductions," she said.

Pawelec said Romney remains urgently concerned about rampant use of heroin and has directed Public Health Commissioner Christine C. Ferguson to review substance abuse services provided by state agencies.

Bonita Richardson is the face of the region's heroin crisis -- and an example of what happens when services have to be cut. Heroin has defined Richardson's life for more than two decades, beginning before she was old enough to drink and stretching into the start of middle age. Finally, she said, at the age of 42, "I'm sick and tired of using drugs. It's just that simple. I'm at the end of my innocence."

So, early in March, Richardson contacted Community Healthlink, which provides substance abuse and mental health treatment in the central part of the state. But for nearly three weeks, the Worcester agency had no space, forcing Richardson to wait.

"I kept calling for a bed, and I kept using drugs," said Richardson, who began receiving treatment last Wednesday. "Every day, I was strung out on drugs. I used as much as I could. If people want to get help and they can't get it, they're just going to do more destructive things to get their drugs."

The effects of delaying treatment, substance abuse specialists said, ripple far beyond the users.

"It creates a lot of human misery for those patients, but also a lot of attendant pain and cost for society," said Deborah Ekstrom, president of Community Healthlink. "If those patients are really in a medical emergency, they go to the hospital emergency rooms where they take up attention and medical resources that would otherwise be devoted to other people. So if you go in there with a broken arm, you wait longer."

State Representative Peter Larkin, assistant vice chairman of the House Ways and Means Committee, expressed little optimism about being able to find additional state dollars for substance abuse services. Lagging economic conditions in recent years left legislators with little room to navigate as tax revenues dropped, said Larkin, a Democrat from Pittsfield.

Federal authorities, he said, should recognize the financial distress of states such as Massachusetts and not impose even more hardship by reducing grants.

That's what happened last year, when the federal government did issue a waiver to Massachusetts, accepting the economic hardship argument. But this year, that position has already been rejected, with a letter from an agency executive stating that the state failed to prove it was beset by "extraordinary economic conditions" that warranted an exemption.

Another House member, Dorchester Democrat Martin J. Walsh, said he believes that if his colleagues move swiftly, they might succeed in changing the minds of federal authorities. Walsh has proposed restoring $4.5 million from what has been excised from the state's Bureau of Substance Abuse Services in the hope that federal authorities will see that as a good-faith gesture and not reduce the grant.

Walsh has sent a letter supported by about 30 legislators to the House Ways and Means Committee asking for the additional dollars.

"It's absurd that we are leaving $9 million on the table when we have people dying every single day," Walsh said. "I'll tell you right now, if we as a Legislature don't restore some of these funds, more people are going to die, and it's going to be our responsibility if these people die."

Stephen Smith can be reached at stsmith@globe.com.