METHADONE CLINIC CLOSURE & OPIATE ADDICTION RISES 3 PART ARTICLE

This is a 3 part article series that starts with the closure of a methadone clinic which displaces several hundred patients who no longer have somewhere to get their methadone treatment. It follows up several weeks later to show the reprocussions of the clinic closure as well as the increase in addiction related crimes.

It is from the FREE PRESS ONLINE and the original link is

http://freepressonline.com/main.asp?SectionID=52&SubSectionID=78&ArticleID=8749

Methadone Clinic Closure Raises Questions
8/26/2010 10:57:00 AM


Clinic served 270, according to state

by Christine Parrish
Feature Writer

When the Turning Tide methadone clinic was shut down by federal drug enforcement agents on Thursday, August 19, a few weeks after its owner, Ange Fuller-McMahan, was arrested for cocaine possession, a lot of questions followed.

Where would the 270 recovering opiate addicts who received services at Turning Tide now go for treatment? Would this force them onto the street? Why weren't provisions made for a reputable overseer to provide treatment while alternative treatment options were arranged?

And why was Fuller-McMahan, the owner and director of Turning Tide, who had been convicted for heroin possession in 1997, approved for a license to run the clinic in the first place?

Recovering Addicts Must Now Travel

As of last Friday afternoon, 81 percent of the Turning Tide patients were reassigned to other clinics and transportation was being provided for some of those patients, according to Guy Cousins, director of the Maine Office of Substance Abuse (OSA). The closest methadone clinics are in Bangor, Waterville, Westbrook and Portland.

Cousins said that after Fuller-McMahan was arrested two weeks ago, he was notified that there was an active federal investigation of the Turning Tide clinic. Cousins started looking for alternative clinics as a backup plan. The Federal Drug Enforcement Agency (DEA) gave the Office of Substance Abuse a two-day warning that they would close the Rockland clinic, said Cousins.

Prescription Addiction Problem "Huge"

"People don't think there is an addiction problem in the area," said Cousins. "There's a huge problem and it's mainly from prescription drugs. After all, it's pretty easy to get a prescription for pain medication. These are not necessarily the people you think. Some are well-connected people, going lower and hitting bottom. Look at the statistics."

The statistics provided by the Maine Department of Health and Human Services show that the admission to a substance abuse treatment facility as result of prescription drug addiction has grown seven times since 2001 in Knox County alone, with notable spikes in the numbers from 2008 to 2009. In 2009, 369 people addicted to prescription drugs were admitted to a treatment facility in Knox County, with Lincoln, Waldo and Sagadahoc admitting fewer than 150 people each. The statistics did not specify to which facility patients were admitted.

Methadone Clinics Subject to Fed & State Regs

At the state level, licensing goes through at least two agencies: one within the Department of Health and Human Services and one related to the Maine Board of Pharmacy, according to Cousins. At the federal level, the Federal DEA oversees the methadone, an opiate that has been used to ease stronger opiate addictions since the 1960s. Federal accreditation is also required to operate legitimately.

The OSA provides technical advice for state licensure, so Cousins was familiar with the licensing process. The owner of Turning Tide complied with all the state licensing requirements, said Cousins, and met federal accreditation requirements.

"Nothing was triggered," said Cousins, referring to the oversight. "Prior to the arrest of the owner, there was no information on impropriety."

"A previous criminal conviction doesn't preclude someone from applying for a license," he said, noting that the law had been misrepresented in some media. The state licensing qualifications state that the clinic "shall not hire any person who has a prior criminal conviction . . . that pertains to client abuse or exploitation."

A former criminal conviction for drug possession does not disqualify an applicant.

"We are in the field of rehabilitation and historically a large part of the workforce was from the recovery community," he said. They recovered and they wanted to give back, said Cousins, so an applicant with a history of drug use or possession isn't uncommon.

According to Cousins, Fuller-McMahan, as owner/director of Turning Tide, was the one responsible for hiring an outside firm to do background checks on her employees and submitting those to the state for review.

To be granted a state pharmacy license, a background check is conducted on the person or people applying for the license, according to Office of Licensing and Registration (OLR). Turning Tide was originally granted a pharmacy license in August of 2007, according to Doug Dunbar of OLR, so a background check was conducted. Reviews of the pharmacy aspects of the clinic are conducted annually, said Dunbar.

Why Not Methadone Clinics in Hospitals?

The underlying question of why methadone clinics are not affiliated with traditional health care facilities that have internal oversight and review processes firmly in place - like a hospital - remain only partially answered.

"It would be more expensive," said Cousins.

Roy Hitchings, the CEO of Pen Bay Healthcare agreed, but said expense was not the only reason.

"We are concerned," said Hitchings, referring to the closure. "We've gotten a lot of calls from patients affected by the closing."

Pen Bay Healthcare held several conference calls with Midcoast Mental Health and Spring Harbor Hospital, the psychiatric hospital in southern Maine, about the closing of the Rockland clinic. Together, they asked Acadia Hospital in Bangor about taking over the Rockland clinic. They refused.

"We're looking at the problem, but at this point, we don't seem to be able to help," said Hitchings. He said Pen Bay lacks the expertise or licensing to dispense methadone. Hitchings said some Pen Bay physicians are licensed to administer suboxone, a methadone alternative that works for some opiate addicts and does not provide a street high that can be obtained from abusing methadone. It also does not cause death by overdose.

"As you know, we are short on primary care physicians in the area, so it's hard to get a new doctor," said Hitchings. The focus at Pen Bay has been on prevention and education at the front end of the pain prescription process in order to prevent addiction in the first place, and counseling.

If opiate addicts come to the emergency room for care, Hitchings said all the hospital could do is treat their symptoms.

"We don't administer methadone," he said.

PART TWO

Midcoast Brushes Off Public Health Problem
9/2/2010 8:43:00 PM

by Christine Parrish
Feature Writer

The shutdown of the methadone clinic in Rockland by federal drug enforcement agents last month, which leaves 270 opiate-addicted people without a local clinic, did not register with government officials as a community public health problem or a public safety issue.

"There has been no discussion by the Select Board about the closing of the clinic," said Rockland City Manager Rosemary Kulow. "As far as the city goes, it's a zoning issue."

Rockland City Attorney Kevin Beal said he was unaware of any company interested in reopening the clinic. The clinic could be reopened under the auspices of Turning Tide, Inc. if the company chose to sell, without requiring a zone change, he said.

Guy Cousins, director of the Maine Office of Substance Abuse, said it was not up to the state to provide an alternative methadone pharmacy. OSA did help with transportation to other locations. The closest clinic is The Discovery House in Waterville; 180 midcoast patients are now going there, according to Clinical Supervisor Jody Bither.

Knox County Sheriff Donna Dennison was more direct about the impact of the closure.

"Too bad, so sad," she said.

Communities ignore the population of the severely addicted at their own risk, according to Brent Scobie, the Clinical Supervisor for Acadia Hospital, a mental-health and substance abuse hospital in Bangor, which operates a methadone clinic in its facility.

"It's not to say that methadone is the only treatment option, but severe opiate addiction pretty much requires some replacement (drug) therapy," he said. "For low and moderate opiate addiction, it's not necessary."

Most addicts in Maine start out on legally prescribed prescription painkillers, which are not difficult to get, he said. Once addicted, many switch to sniffing opiates. In Maine, the data show it takes about five or six years before an addict seeks help at a methadone clinic, according to Scobie. By then, the addiction can take over a life, he said.

"These people stay in their communities," said Scobie. "People abruptly stopped from methadone treatment have a high rate of opiate relapse. It's tremendously expensive and they have an incredible need for finances. They beg, barter, steal, sell themselves, sell other drugs to support their habits, and do other dangerous things, like re-use or share needles."

"It's a community-based problem, and it's an advantage to the community to think about treating them," he said.

According to Scobie, the data collected on treatment indicate that 80 percent of patients have very low rates of relapse. The stereotypes of methadone users who are selling drugs and getting high are the other 20 percent, according to Scobie. For most people, the treatment allows them to live a normal life, he said.

"It's been in use for fifty years," he said. "It's a proven therapy for addiction."

PART THREE

Opiate Addiction Rises: Treatment Requires New Thinking
9/9/2010 10:55:00 AM

by Christine Parrish
Feature Writer

When the Turning Tide methadone clinic was closed last month as a result of a federal Drug Enforcement Agency (DEA) investigation, little planning went into addressing the patient population that it served. One day the clinic was open, the next day it was closed. The federal investigation is still in progress.

Prescription drug abuse is a documented problem: the rate of people seeking help from health care facilities for prescription drug abuse has tripled in Maine in nine years, according to the Maine Office of Substance Abuse (OSA). In Knox County, it has quadrupled.

Laurel Moran of the Midcoast Mental Health Crisis Stabilization Unit said the closure of the methadone clinic has had a big impact.

"We're getting three to five requests for detox a day, or they end up in the ER at Pen Bay, or as inpatients at the PARC Unit," said Moran.

The Psychiatric and Addiction Recovery Center (PARC) at Penobscot Bay Medical Center is an acute in-patient psychiatric and medical detoxification treatment center for adult patients. The unit has 18 beds and is locked.

"Opiate Abuse Is Huge in Midcoast"

"Opiate abuse in this area is huge," said Moran, noting that the 270 patients at Turning Tide were the ones being officially treated. Some methadone was making it onto the streets where people were treating themselves in trying to get off prescription painkillers, she said.

"These are not the people you think," she said. "We had a 70-year-old woman who got addicted after a broken hip, we have fishermen. And younger people."

Moran said painkillers were widely and legally available for a while. As an example, she said her son got his wisdom teeth out a decade ago and was prescribed a tall bottle of OxyContin, one of the most heavily abused prescription opiates.

"He took one," she said. "And then we had this whole bottle we ended up flushing down the toilet. Can you imagine the street value on that?"

Brent Scobie, the Clinical Supervisor for Acadia Hospital in Bangor, said he was very concerned about the abrupt end of methadone treatment in the midcoast.

Opiate addicts may end up using street heroin to continue their habit, but most start out addicted to prescription painkillers like oxycodone or OxyContin, an opiate derivative, according to Scobie, who supervises mental health and substance abuse treatment at Acadia Hospital.

For the severely addicted, a replacement drug therapy, of which methadone is one option, can act as a bridge to being drug-free. Scobie said the severely addicted who are being treated with methadone are much more likely to relapse without a local therapy provider.

There is more than one way to provide it.


Option: Hospital-Based Methadone Clinic

Scobie has seen viable alternatives to a stand-alone, for-profit methadone clinic. The model that Acadia Hospital favors is an outpatient Replacement Therapy Program (RTP) that is based in local hospitals.

For-profit methadone clinics require a certain caseload of patients to make the clinic profitable, so they tend to be located in larger city centers, he said. That leaves rural opiate addicts out on a string, particularly if they lack transportation.

"Having an RTP in a hospital setting has advantages in terms of treating other conditions," said Scobie. "Take, for example, a pregnant woman who gets replacement therapy and ob-gyn services. Or an emergency department with an opiate overdose. The patient can be evaluated, treated, and engaged in therapy under the same roof. It allows for continuity of care. A stand-alone clinic loses that; it doesn't address those other medical needs."

A hospital-based RTP, like the one at Acadia Hospital in Bangor, also tends to rank higher in public opinion than a stand-alone clinic, said Scobie.

"We get a benefit because we are a hospital," said Scobie, of Acadia Hospital. "There is a formalized structure in place. But it would depend on the hospital. There are concerns about offering addiction replacement services."

Roy Hitchings, Chief Executive Officer of Pen Bay Healthcare in Rockport, said Pen Bay Medical Center lacks the expertise or licensing to dispense methadone, but some physicians are licensed for other opiate replacement therapy. However, getting an appointment with them is difficult, he said, because most primary care physicians in the area are not taking patients. Hitchings said Pen Bay puts its efforts into prevention.

Dan Bennett, Director of Operations at Waldo County General Hospital in Belfast, said there had been little effect due to the closing of Turning Tide. The emergency room has referred patients to other methadone clinics in the state, said Bennett, but the hospital is not set up to address addiction services.

James Donovan, President of Lincoln County Health Care in Damariscotta, said the area hospitals are not seeing any impact from the closure from the methadone clinic, nor has there been any discussion about it.

"It is not something we talk about," said Donovan. "I hear it more from the primary physicians in practice, particularly those who do chronic pain management."

"I do think it is a public health problem statewide, but I have a feeling it's a larger issue in larger population areas," he said.

It's true that the numbers are not high in Lincoln County, but admissions to a Lincoln County health care facility for abuse of prescription drugs has quadrupled in the past nine years, according to DHHS data made available in August.

Option: Mobile Methadone Unit

Another option for a RPT is a mobile methadone clinic, said Scobie.

"Vermont used this successfully in communities that were unwilling to have clinics," he said. "It's basically a high-end unit on wheels that comes and goes back to a secure facility. There is no medication storage in the community."

The mobile methadone clinic parked at a designated spot then moved on to the next scheduled town.

"It could be a model for Maine, 50 people here, 50 people there, 100 over there," he said. "It would cut down on travel and on community impact."

Acadia Hospital has no plans to open a satellite RTP in Rockland.

"Ideally there would be a local group willing to take it on," said Scobie. "We would be happy to offer advisory assistance."

Option: Reopening Turning Tide

John Root, the Code Enforcement Officer for Rockland, said there had been one inquiry about re-opening Turning Tide at the same location. After heated public controversy, Turning Tide, Inc. was granted a contract zone change in 2005 to open the clinic. If Turning Tide, Inc. no longer operates the clinic, the contract zone will no longer apply.

If someone did take over the business, they would have to be relicensed at the state and federal levels.

As to the risk of re-opening the clinic, Scobie says the public safety risk is higher with it closed.

Rockland Police Chief Bruce Boucher said the clinic was not the site of obvious criminal activity, nor has he seen an increase since it closed. "The only difference I've noticed is that there is a lot less traffic in the early morning," he said.

Boucher took over as police chief after Turning Tide was licensed, but he was aware of the controversy in the community over the opening of the clinic.

"You can bet on one thing," said Boucher. "If there is going to be somebody taking it over, you can bet there will due diligence in how it is operated. We will be watching it very, very closely."

I really feel sorry for those very sick people right now. I really hope that never happens to us. Scary. That must really be hard. I couldn't even imagine how they are feeling. I wonder how long they have to drive to the replacement clinic. Well, I wish them the best.