Appendix A includes table with a summary of program activity statistics. The number of admissions to methadone maintenance and methadone detoxification during years 2005 and 2004 are presented. The table also illustrates the proportion of males and females receiving services and the sources of reimbursement for the care provided.

It may be noted that the total number of methadone maintenance admissions for the year 2005 was 159. This represents a reduction in utilization of 30% over the previous year.

In regard to the female to male distribution, twenty nine percent of the group was female and 77% male.

Fifty-five percent of the methadone maintenance services provided to the group were reimbursed directly by clients and for 45% funding for treatment was covered by MediCal.

Two hundred thirteen patients received methadone detoxification care during 2005. This represents a decrease in utilization of this treatment modality of 6% over the previous year. Nevertheless this modality remains over utilized. For most of the patients requesting detoxification, maintenance would be more appropriate.

Concerning the distribution by sex, twenty-one percent of the admissions were females and 79% males.

Eighty-eight percent of the patient group paid directly for the care received and 12% had the services reimbursed by MediCal.

The reasons for a possible decreasing trend in service utilization observed in our program is not clear. However an increased availability in the community of a broader range of opiates has been reported by data bases such DAWN, the Treatment Episode Data Set, the National Survey of Drug Use and Health and other surveys. Prescribed and non-prescribed increases in the utilization and untoward effects of opiates such as hydrocodone, oxycodone, fentanyl and codeine have been reported. These increases affect all age groups. More recently, restrictions to medical availability of buprenorphine have been relaxed. The options and range of settings for medical and non-medical opiate utilization have increased substantially.

We are considering two strategies to address the utilization problem. We will make and increased effort to persuade patients for whom maintenance is more appropriate to pot for this treatment.

We also will make available buprenorphine maintenance. However, we believe that such option should not be made available until the patient has been properly evaluated and observed through a reasonable period of time in a methadone maintenance program. The patient would have to demonstrate an understanding of the risks and benefits of buprenorphine as well as capacity to engage in a stable therapeutic relationship. Skilled counseling as an element of treatment is important given the behavioral, social and rehabilitative issues common to persons addicted to opiates. To provide this treatment engagement in counseling therapy is critical.