Editorial: Methadone clinic poses challenge

Bringing the possibility of siting a methadone clinic in Middlebury to the selectboard’s attention at a meeting last week was the right action taken by the Counseling Service of Addison County. Whether a clinic is eventually sited in Middlebury or not, as CSAC Director Robert Thorn said, the community still needs to address what is an apparent problem throughout the county and state.
Currently five methadone clinics — in St. Johnsbury, Newport, Berlin, Brattleboro and Burlington — serve about 500 patients statewide. But more people are not being served, and there’s a large gap in service along the southern Route 7 corridor between Burlington and Bennington, forcing residents who need treatment to drive long distances.
Thorn told the Middlebury selectboard (see front page story in the June 30 Addison Independent or at www.addisonindependent.com) that 16 county residents are currently seeking treatment at the Burlington clinic, while another 10 remain on a waiting list. With no service in Rutland or Bennington, we can only speculate that that many more patients are going without service in those two respective counties.
It’s important for area residents to contemplate the root of the problem, and the consequence of inadequate treatment.
Contrary to what has been the public perception of methadone clinics, the majority of the patients seeking treatment had become addicted to narcotics not by first taking other illicit drugs, but through prescription pain killers.
Consider a likely scenario: A man wrenches his back working; his doctor prescribes a painkiller to allow the patient to sleep, do physical therapy and make it through the work day. Several weeks later and partially recovered, the painkillers are not renewed, the pain may linger, the need for relief is prevalent but so is that sense of comfort provided by the painkiller.
The cost of a single oxycontin pill on the streets is $50. Heroin, amazingly, is less. If the patient turns to heroin, the subsequent slide downhill for the patient and the family is what the medical community, the town and the state must try to correct.
What society has learned about methadone clinics over the past couple of decades is that they do work for some people; there has not been a rise in crime in the areas hosting the clinics; and because of their presence successful treatment allows patients to get over their addiction while remaining in their homes, at their jobs and with their families.
Fear of crime spreading because of hosting a methadone clinic in Middlebury, therefore, is rationally countered by reason and the past experience of other clinics.
But that doesn’t mean siting a methadone clinic in Middlebury is a rational move. A more realistic concern of Middlebury town officials is whether adequate state resources (through Medicaid) could fund methadone treatment in Middlebury and Rutland, where talk of a larger clinic to serve 100 patients is ongoing. As selectboard chair John Tenny rightly cautions, “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.”
That “population,” of course, is us, and we should be encouraged to take care of our own. But the point Tenny makes is valid: Let’s not commit to a service that we can’t afford, or the state can’t afford, and leaves us short-handed to fulfill the total needs of the patients. Those are the shortages that invite problems.
We also wonder:
•  Why is a common prescription drug like oxycontin priced at $50 a pill on the black market? Is there no better way to meet this need and create programs that wean patients off painkillers before turning to heroin?
•  And it would appear that there is not adequate education on the risks of addiction to patients before they are given painkillers, as well as insufficient programs to monitor that usage before addiction occurs.
I am undoubtedly naive about the medical complexities of addiction and the difficulties of addressing the two above concerns, but for my public dollar I’d rather see Middlebury’s medical community work on developing new programs to head off the addiction first, and let Rutland’s more central location be serve as a methadone clinic for the southwest part of the state. That way the current need for service is improved, while a new effort could get under way to prevent a growing problem.

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