MIDDLEBURY — State and local health care administrators are studying the possibility of opening a methadone clinic in Middlebury, a plan that has some local officials concerned about the prospect of such a service producing a spike in drug-related crime in Addison County’s shire town.
Methadone is a synthetic opioid, similar to morphine. It is used as pain reliever, but also as part of a treatment plan to reduce withdrawal symptoms in people addicted to heroin or other narcotic drugs.
There are currently five methadone clinics in Vermont serving a combined total of around 500 patients who are trying to wean themselves off of narcotics, according to Barbara Cimaglio, deputy commissioner for drug and alcohol abuse programs for the Vermont Department of Health (DOH).
Those clinics are in St. Johnsbury, Newport, Burlington, Berlin and Brattleboro.
“There is a gap in availability along the Route 7 corridor,” Cimaglio said, specifically citing the Rutland and Middlebury areas.
As a result, some patients are traveling considerable distances to get methadone treatment, Cimaglio noted. And many of those patients are covered through the Medicaid insurance program, which defrays transportation costs associated with clinic visits, she said. This has prompted Cimaglio and other state and local officials to consider whether the cost of establishing another regional methadone clinic could be offset by transportation expenses currently incurred through the Medicaid program.
“Funding, of course, is an important consideration,” Cimaglio said.
Robert Thorn, executive director of the Counseling Service of Addison County, or CSAC, said 16 Addison County residents are currently being served by the Burlington methadone clinic, called the Chittenden Clinic. Another 10 country residents are on a waiting list for service.
“I have made it pretty clear that I think there is a need in Addison County and I’d like to try and address that need,” Thorn said.
Thorn and other CSAC officials are talking with their counterparts at the HowardCenter — which runs the Chittenden Clinic — about collaborating on a Middlebury methadone clinic to achieve some economies of scale in administration and staffing. Thorn indicated such a clinic would require at least 40 patients to be viable.
Rep. Michael Fisher, D-Lincoln, told Middlebury officials at a Middlebury selectboard meeting Tuesday that he believes there are now “easily” 40 Addison County clients who could benefit from a methadone clinic. Fisher is an outreach worker for the Addison County Parent-Child Center who said virtually every one of his clients is now affected by narcotics, either directly or through association with a family member.
“The problem is here,” Fisher said. “For 25 years, opiate addiction has been in the families I have worked with.
“I am on the streets saying, ‘We have a desperate problem here,’” Fisher said. “It’s not showing up at a clinic’s door, but it’s showing up in opiate-addicted women who are pregnant; it’s showing up in at the emergency room, at the counseling service, at our homes where people are breaking in and stealing bottles of coins. It is here, and it is part of our community.”
Bob Bick, director, Mental Health and Substance Abuse Services for the HowardCenter, said the Chittenden Clinic has proven very successful in providing comprehensive services for addicts. He noted most of the clinic’s clients became addicted to narcotics through prescription painkillers. Bick explained that in some cases, a patient’s craving for the drug continues well after the prescription runs out, prompting the patient to seek a new supply illicitly. At $50 per pill on the streets for an oxycontin narcotic pill, Bick said he has seen some patients instead gravitate toward heroin — a cheaper narcotic.
Bick called methadone “another tool in the toolbox” to help recovering addicts. “It is not the right tool for everyone,” he said.
But it has proven an effective tool for around 250 patients at the Chittenden Clinic, according to Bick, who said patients are randomly screened for drugs through urinalysis, and more than 95 percent of them have been testing clean.
Bick met last week with DOH officials, who received a draft budget for a proposed 100-slot methadone clinic in Rutland. Bick said Vermont DOH Commissioner Harry Chen was “very supportive of the idea,” which will be further developed in collaboration with Rutland Mental Health Services.
Meanwhile, Thorn stressed CSAC officials are not close to a decision on locating and/or funding a Middlebury clinic, but added it’s a project that needs to be considered. Thorn told the selectboard he began thinking about such an offering during the past year after a Middlebury resident approached him, in tears, recounting how her son had recently become addicted to heroin. She noted there was a waiting list at the Chittenden Clinic and could not get methadone help for her son.
Thorn referred to a recent needs assessment survey and evaluation performed by the Addison County Court Diversion and Community Justice Project. That report, Thorn said, indicated “drug treatment” as being the biggest gap in community services in the county.
“We concluded as an agency and as a board of directors that this is a serious problem, and we are at this point seeking the best approach to address this problem,” Thorn said.
“I am here to say we are looking at this,” he added. “But, in part, this is a community problem. I hope, and we encourage you all, to engage with me and others, to figure out what we are going to do about this problem.”
Selectman Craig Bingham is director of the Turningpoint Center of Addison County, which provides services to people recovering from substance abuse. He offered the Turningpoint Center’s assistance in the methadone clinic effort, but also suggested methadone substitutes — such as Suboxone and Buprenorphine — be considered as part of treatment. Such drugs produce a less euphoric state in those using them to wean themselves off of narcotics.
IMPACT ON TOWN
Talk of a methadone clinic has fueled concerns about potential impacts such a service could have on the town.
“We have to be very concerned about anything that might stimulate an increase in drug activity in the community,” said Middlebury selectboard Chairman John Tenny.
Among other things, Tenny wonders if the presence of a methadone clinic might prompt clients to relocate to Middlebury, and of the potential of some resorting to crime if their treatment proves unsuccessful.
“I don’t know if that’s true or not, but it’s a concern,” Tenny said.
Town officials also expressed concern about whether the clinic would offer walk-in services or substantial in-house programs, and the extent to which clients would be monitored while in the area. Tenny said he believes it’s important that prospective methadone clients receive well-managed services so that the service is well integrated into the community.
“We need to turn to you and say, ‘If you’re going to do this, we have to be very careful we are encompassing a total program that is seeing to all the needs, and that we aren’t somehow otherwise stressing the community with a population that is not properly managed,’” Tenny said.
Middlebury Police Chief Tom Hanley said his department has worked effectively with local nonprofits that are providing a variety of medical and mental health services.
“Provision of these services generally does not overburden police services and we work closely with service providers to mitigate any adverse effects on the community,” Hanley wrote in reply to an e-mail for comment on the potential siting of methadone clinic.
“On the other hand, people with opiate addiction present a higher risk for criminal activity — burglary, larceny, fraud, drug trafficking and even gang relations — than do those seeking other types of services,” Hanley continued. “And therapy for opiate addiction is only available in a few areas of the state. While we maintain an open mind on this matter, we are very much interested in the plans the provider has to mitigate the adverse effect on the community, especially the downtown, and we will follow this project very closely. I hope that the project, in its final form, recognizes the risks and while seeking to minimize them also works to reduce the current epidemic of opiate addiction in our area.”
Cimaglio is aware of the town’s concerns, and heard them in other communities prior to hosting methadone clinics. She recalled a lively debate prior to the establishment of the St. Johnsbury clinic.
“When the program rolled out, there was very little that happened,” Cimaglio said. “There was no increase in crime. It really was a non-event.”
Cimaglio argued that patients are less likely to get involved in criminal activity if they are in methadone treatment. And she said there is little evidence to support the notion that clients tend to relocate to the community in which methadone is offered.
Thorn recently toured the Chittenden Clinic in Burlington and reported a “well-run operation” with good security. He said clients were under strict rules not to loiter near the center. Dosing, he said, went like clockwork and took place mainly in the early morning hours so people could get to jobs.
“It’s not a location where people stand around outside, smoking cigarettes,” he said.
Reporter John Flowers is at firstname.lastname@example.org.