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Opiate Addiction Rises: Treatment Requires New Thinking

Opiate Addiction Rises: Treatment Requires New Thinking.

Opiate Addiction Rises: Treatment Requires New Thinking
9/9/2010 10:55:00 AM Email this articlePrint this article
This is the third article on this issue by Christine Parrish. Scroll down to see links to the earlier two articles, including Part 1 of this installment.

part 2 —

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.”

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