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Why is methadone free but chemo isn’t? - (11/6/2018)

By Dr. Ron Gasbarro

“Doesn’t seem fair to me,” Jake said to the pharmacist. “Why is methadone free for drug addicts but chemotherapy is not free for cancer patients. Surely, people with cancer are more deserving of a cure than a junkie!” Judgmental Jake. Always splashing his opinions onto those around him. 

The pharmacist explained to Jake that cancer and addiction are not comparable diseases. Cancer is very complicated and involves a regimen of multiple drugs and other therapies, such as radiation. Cancer is an umbrella term for 200 malignant diseases caused by combinations of genetics, environment, and lifestyle. Some of these diseases, such as pancreatic cancer, are more deadly than prostate cancer, for which there are diagnostic tests that pinpoint a malignancy in its earliest, and most curable stage. New, targeted therapies have been developed that attack the cancer cell directly, avoiding the harsh side effects of chemo, such as hair loss, and mouth sores.  

Chemotherapy can be expensive. The costs of chemotherapy can run as high as $30,000 over an 8-week period, according to the American Cancer Society. The average cost for an initial treatment is approximately $7,000. Expenses differ depending on the drugs, the stage of the cancer, and other factors specific to each patient. Consider breast cancer. For patients covered by health insurance, out-of-pocket costs for breast cancer treatment typically consist of doctor visits, lab, and prescription drug co-pays. Co-insurance of 10%-50% for surgery and other procedures can easily reach the yearly out-of-pocket maximum. Health insurance typically covers breast cancer treatment, although some plans might not cover the priciest drugs or treatments. For patients with no health insurance, breast cancer treatment costs $15,000-$50,000 for a mastectomy or $17,000-$35,000 for a lumpectomy followed by radiation.

Unlike cancer therapy, drug addiction treatment is more cut-and-dried. Methadone is a controlled substance used to treat opioid dependence. Specifically, methadone works by “occupying” the brain receptor sites affected by opiates. The result is that methadone blocks the euphoric and sedating effects of opiates while relieving cravings and symptoms associated with withdrawal from opiates. Methadone does have its drawbacks. Like heroin, methadone produces a long list of side effects, including euphoria. One can become addicted to it, therefore, the doses must be carefully monitored. Moreover, it does not cure addiction. It simply makes it easier for the patient to quit abusing opioids. 

While methadone is a relatively inexpensive generic drug, it is not always free. There are public and private methadone clinics for the treatment of drug abuse. While private clinics are not free, public methadone clinics are government-funded, have a waiting list, and are generally paid for by the taxpayers. The sad part about methadone replacement therapy is the high recidivism rate. Addicts can be treated for months only to slip back into their habit. This wastes taxpayer money. Opioid withdrawal must be coupled with peer group support and educational services. This involves more of your money. 

The pharmacist made clear to Jake that addiction is a disease like cancer. While cancer affects the cancer patient and his family, addiction can destroy society, with high crime rates, and loss of life. Right now, there is no answer to addiction. However, addicts should not be prosecuted through imprisonment, or ostracism, neither of which addresses the physiologic basis of addiction. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com 

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