On March 29, Congress and the President eliminated drug and alcohol addiction as a disability under SSI or SSA. This program provided small cash benefits and eligibility for Medi-Cal to recipients. Over the years, hundreds of patients have used their cash benefits to pay for methadone treatment in our program when Medi-Cal did not cover the service. In the past year, since the Sobky vs. Smoley lawsuit ended limits on drug treatment benefits for Medi-Cal recipients in California, Medi-Cal has been the vehicle for thousands of addicts throughout the state to gain access to both methadone and other forms of drug treatment. Sacramento County, for reasons that aren’t clear, has the second highest number of disabled substance users in the state, exceeded only by LA County. Now, about 4,500 addicts in Sacramento stand to lose their access to treatment, and many will also become homeless.

I have had three patients in my office in the past week who were acutely suicidal after they received their letters of termination. They had been stable and in recovery. Two of them had relapsed. They saw the end of treatment access as leading to an inevitable return of addiction. Suicide seemed a better option. So, the first accomplishment of this legislation has been to increase drug use among people who weren’t using and to drive people to the verge of suicide.

Now that a large number of intravenous drug users are in treatment where we want them (if we really want to reduce infectious diseases, crime, and disability associated with drug use), the bipartisan political decision is to kick them out, with no provision for continued access to treatment. They will become the responsibility of counties, who, in a display of moral and fiscal irresponsibility flowing downhill, have introduced a bill in the state Legislature to relieve themselves of any responsibility for providing general assistance to those denied federal and state benefits. This is an attempt to make a group of people not exist, at least until they surface in our hospitals, homeless shelters, and prisons, where cost/benefit analyses show they will cost the taxpayers 10 times what these SSI health care benefits cost.

Having decided to eliminate benefits that kept people in treatment, the President is gearing up for a "war on amphetamines." Many of the people President Clinton has just decided to leave without access to treatment are amphetamine users in recovery. Many, if not most, will return to amphetamines without access to treatment. The political goal here is obviously not to do anything real about reducing drug demand. It is not to stop the spread of HIV and hepatitis C that are ravaging out-of-treatment drug users, especially amphetamine users. No, the goal is to get elected by pretending to be "tough on drugs." Drug policy as it is practiced in the US seems little more than a cynical vehicle for campaign propaganda.

Many, if not most, of these patients have other mental health problems and physical disabilities. These disabilities were ignored once the patients stated they also had substance abuse problems. Now, patients will be forced to make an entirely new application to SSI to have these coexisting conditions considered. This poses an enormous logistical problem. Congress has mandated that reapplications must be completed — including the medical and psychiatric assessments — by July 28, 1996 or there will be a lapse in benefits, which would be catastrophic for many of these gravely disabled patients. Here in Sacramento, this means organizing resources to do as many as 4,500 evaluations, mostly psychiatric but many for physical disabilities like hepatitis C. 3acramento County Health Department has hired six social workers to coordinate the process, but physician help will be needed to do the assessments.