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Methadone Clinic Closure Raises Questions

Methadone Clinic Closure Raises Questions.

Methadone Clinic Closure Raises Questions
8/26/2010 10:57:00 AM Email this articlePrint this article
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.

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