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Abstract
Over the past decade in the United States, federal funding for methadone maintenance has diminished by more than one third. Increasingly, private, fee-for-service methadone has replaced publicly supported treatment. This defunding and privatization of methadone maintenance has resulted in clients being forced out of treatment because they are unable to absorb the cost of private fees. This paper outlines the historical shift in the funding base for methadone maintenance in the U.S. and examines the outcomes associated with fee related detoxification from methadone. Twenty defunded clients who have lost public funding for their methadone maintenance are followed over time and compared to 76 clients who have not lost their funding source in three areas: heroin injecting, needle sharing, and high risk sexual practices. The implications of the findings for public policy, particularly in the era of AIDS, are discussed.