Pubdate: Sat, 02 Sep 2000 Source: Bangor Daily News (ME) Copyright: 2000, Bangor Daily News Inc. Contact: http://www.bangornews.com/ Author: Renee Ordway, Of the NEWS Cited: The Lindesmith Center - Drug Policy Foundation: http://www.drugpolicy.org/ National Institute on Drug Abuse: http://www.nida.nih.gov/NIDAHome2.html BANGOR TORN IN DEBATE OVER METHADONE TREATMENT CLINIC BANGOR - The contentious debate over a proposed methadone clinic has divided some of the community's most prestigious leaders and confounded residents torn between wanting to help those caught in the downward spiral of substance abuse and maintaining the safety and serenity of their city. The public has been told that the clinic will bring drug addicts and dealers to town, making Bangor a "mecca - a farmers market" for drug dealing. Crime will go up and the heroin problem will become deep-seated and permanent. Demand for city services such as public housing and police will increase. They also have been told that the clinic will reduce heroin use by 70 percent, decrease crime by 56 percent and increase employment of heroin addicts by 24 percent. Supporting the clinic is the city's largest employer, Eastern Maine Healthcare, which encompasses Acadia Hospital, the would-be operator of the proposed methadone treatment facility. They are backed by EMH's and Acadia's boards of directors, which include some of the city's most civic-minded leaders. Weighing in is a very skeptical city council, school board, police chief and the state's United States Attorney. It's easy to get lost in the flurry of words tossed about by those involved. Some call it a battle between the who's who of the city. Others call it an aggressive democratic debate. Some call it a methadone clinic, while others insist it is simply part of the hospital's treatment center and not a clinic. Those who go are either "clients" or "addicts," depending on who's speaking, and methadone as a treatment has either a 50 percent success rate or a 50 percent failure rate, depending on who's presenting the argument. This much we know from examining methadone clinics around the country and in southern Maine: Few if any communities have been successful at keeping methadone clinics out of their cities. Methadone remains the most effective treatment for opiate addiction, though new drugs are on the horizon. And whether clinics result in a crime increase or decrease seems to depend on where they are located and how they are run. We also know that the presence of two clinics already in Maine has done little to decrease the overall opiate and heroin addiction problem in the state. South Portland's experience South Portland Police Chief Ed Googins has followed the Bangor debate closely. He knows if he gets a call from Bangor these days it is most likely someone with questions about methadone clinics. Googins probably has more experience with methadone clinics than any other chief in Maine. A clinic opened in his city of 22,000 people in 1995. So what's happened? "We have seen a slight decline in most crime, but there is no way to connect that to the presence of the methadone clinic. Communities across the country are seeing a decrease in crime. Most of those communities don't have methadone clinics. Also, it should be noted that in the mall area [near where the clinic is located] we have seen no decline in crime and slight increases in property crimes such as shoplifting and car burglaries," Googins said. "There is also no way to say that's due to the location of the clinic. " The clinic has not resulted in a reduction of the abuse of heroin and diverted opiates in the Portland area, Googins said. "We, like most communities, are seeing an increase in the use of heroin and opiates," Googins said. "Our biggest increase has been in the use of heroin and OxyContins. " In its 1999 report, the Maine Drug Enforcement Agency's Portland office reported that heroin had increased in both availability and strength in the area. "This particular area has always had a core group of [heroin] addicts, which is estimated to be between 900 and 1,200 in the Greater Portland area. Some of the noticeable changes are that there seems to be a younger user of this drug. We have also seen a marked increase of heroin overdoses ," the report states. "This unit has experienced a large increase in the availability of virtually every type of pharmaceutical drug. " The increased heroin problem has not been attributed to the methadone clinic, but raises questions as to whether the presence of a clinic in a community reduces the drug problem there. Though not necessarily an advocate for methadone clinics, Googins sees a need for medical treatment for addiction. "I wouldn't say I'm a fan of methadone clinics. I see the need for medical treatment. I'm not necessarily an advocate for a clinic situation. We have had issues with the clinic, but they are not overwhelming But we have had undercover drug operations that have led us to the doorstep of thatfacility," he said. Examining The Clientele The desire to see a clinic in Bangor drew 37-year-old Karen Dittman to a crowded public hearing in the city in July. The business owner and mother from Ellsworth waited four hours for her chance to speak, but finally gave up as the hearing dragged on. A clinic in Bangor would save Dittman the two-hour drive each way to the Winslow methadone clinic, which she makes once a week. It's taken her years of methadone treatment, counseling and clean urine tests to be entrusted to take a weekly dose of methadone home with her rather than commute daily. But with a busy 14-year-old daughter, a husband and a successful candle-making business, the five hours that it takes for her to get he treatment each week is tiring. "I'm not complaining because I need to go and I'm lucky I just have to go once a week. I went every day for a long time and then it was a few times a week. No matter what, I'll go because I need the methadone. It has saved my life and allowed me to be a proper mother to my daughter. It means everything to me," she said. Diagnosed right after her daughter was born with a painful disease that affects her circulation, Dittman was prescribed Vicodin. Over time, her need for the drug increased, until the day came when she realized she was addicted. "I knew for a long time before anyone else did. I mean, I was living a normal life. I was working and raising my daughter, but I was an addict and when I tried to get off them I got so sick. I mean, all I can tell you is to recall the worst flu you've ever had and multiply by at least 10," she said recently from her business located on Route 1 outside Ellsworth. Dittman never had visualized herself as an addict. She had a nice family and was raised in a small town in central Maine. "It was an awfully difficult thing to admit. I mean, no matter how bad it got I was always looking at other addicts and saying 'That's not me. I'm OK. I'm not like them. ' Of course I was just like them," she said. After several failed traditional detoxification and rehabilitation programs, and one night in jail, Dittman sought help at a methadone clinic in South Portland. It seems silly to her that her own doctor can't prescribe methadone to her to save her the weekly trip. Federal legislation prohibits physicians from dispensing methadone to treat addiction. The Bangor clinic would certainly be more convenient. Location Questions It's probably not the Karen Dittmans that Alfred Mosca is worried about, but he's worried nonetheless. "We have a wooded area that borders the back side of the houses on Dunning Boulevard [near the Acadia Recovery Community and the site of the proposed methadone facility]. There are encampments there that are occupied by these patients from Acadia. We've had at least five incidents where these people have approached the homeowners and demanded that we give them alcohol, beer. During the daytime they're free to come out in the back yards ," Mosca said during a July 19 public hearing. Ideally, Acadia officials say, clients will come to the clinic early in the morning to receive their dose and counseling services and then go about their day. The proposed clinic will be located on the former Dow Air Force Base, in the area of University College across the street from the airport. The South Portland clinic is located in a commercial area nestled between business offices and retail stores, near the Maine Mall. Chief Googins said his department is called "regularly but not frequently" to the clinic. It is not a pedestrian-friendly area, he said, and the complaints that are made usually involve speeding or dangerous driving of those going to and from the clinic. The chief said clients do not hang out around the clinic. "They pretty much park their cars, go inside, stay for a short period of time, come out and drive away. That's about it," said the chief. Though undercover drug investigations sometimes turn up information involving clients of the clinic or diverted methadone, drug dealing around the clinic has not been an issue, said Googins. At the same time, even Dittman acknowledges that some methadone clients continue to use drugs, such as cocaine. Barbara McCauliff of Portland also says that a number of methadone clients are still rooted into the drug culture and leave the clinic and head to Massachusetts to pick up a bag of cocaine. "Some of them are there to get clean and get their lives back," McCauliff said. "Others are there to get the methadone, the drug. If they are on Medicaid they can get a free dose of methadone every day. They are using it as a recreational drug not to get clean. " Jim Crocker is the morning disc jockey on the WGAN radio station, located adjacent to the South Portland clinic. "You'd never know what it was," said Crocker in a recent telephone interview. "There's a sandwich shop on the other side of the clinic and that clinic could be just another sandwich shop, except when the people come out they don't have a hoagie under their arm. " Crocker said the clients arrive, go inside and then leave. "And I'll tell you something, a lot of them are driving nicer cars than we are and a lot of them are in suits and ties," said Crocker. "I have never seen a problem over there. " Conflicting Statistics Margaret Rutan listened patiently as the success and failure rates of methadone treatment were tossed about during the July 19 hearing at the Bangor Civic Center. "Whose statistics will we address to make a final decision?," Rutan asked the city council. Mayor Michael Aube's noncommittal answer may sum up some of the frustration lurking behind the methadone debate. The purpose of the meeting, Aube responded, "is to raise the questions. You're doing so. I think that's a very legitimate question for this council to consider in terms of statistical information, so we'll note it and move on, but we can't answer that tonight. " Definitive answers are hard to come by when searching for accurate statistics involving success or failure rates. The science appears to be on the side of Acadia Hospital and the state's Office of Substance Abuse, which wants a clinic in Bangor. There is nearly endless research that provides strong evidence to support methadone maintenance as the most effective available treatment for heroin addiction. Methadone treatment is supported by the American Medical Association, the American Psychiatric Association, the Center for Substance Abuse Treatment, the National Institute of Health, and the Institute of Medicine. The White House not only supports methadone maintenance treatment, but also introduced legislation to make it more widely available. The National Academy of Science's Institute of Medicine found that "methadone maintenance has been the most rigorously studied drug treatment modality and has yielded the most incontrovertibly positive results. " Methadone is an opiate that wards off withdrawal symptoms and suppresses drug cravings among opiate addicts by stabilizing blood levels of the drug and its metabolites. Experts maintain that methadone lets addicts function normally, without making them high and can safely be consumed for years. Some experts have compared it to the nicotine patch used by smokers who want to quit the habit. "Both deliver addictive drugs - albeit drugs that pose virtually no health risks - in a form designed to reduce associated harms to consumers and others. Both have proven effective in reducing more dangerous forms of drug consumption," according to a report authored by Ethan Nadelmann, director of the Lindesmith Center, a drug policy research institute in New York City. Gen. Barry McCaffrey, the director of the Office of National Drug Policy. cites a National Institute on Drug Abuse Treatment Outcome Study that found that methadone reduced heroin use by 70 percent and criminal activity by 57 percent while increasing full-time employment 24percent. The study sponsored by the National Institute on Drug Abuse compared before and after treatment behaviors of 10,010 drug abusers in nearly 100 treatment programs. The study found that those who used heroin weekly before treatment, compared to those who did 12 months after treatment, resulted in a 69 percent decrease. The study did not address whether those clients were using heroin at all, but instead indicates that the frequency of use had decreased. Maine U.S. Attorney Jay McCloskey questions all of those statistics because they are based on self-reporting by methadone clients. "First of all, the [researchers] set a very low bar for the definition of effectiveness. Any decrease in the use of heroin is seen as effective treatment. And they rely on self-reports by addicts. They are not going to self-report that they themselves are using drugs when they are at a methadone clinic " McCloskey told city councilors. The U.S. Attorney further questioned McCaffrey's statistic showing that full-time employment increased by 24 percent for methadone maintenance clients. McCloskey argued that in Maine 80 percent of those receiving methadone are on Medicaid. McCaffrey's office later corrected the initial figure stating that full-time employment among methadone clients increased only by 4 percent. McCaffrey also stated in a recent NEWS article that methadone allows for 175,000 Americans to lead stable lives. Yet it is estimated that only 170,000 people are receiving methadone treatment and at least a significant percentage of those clients will fail treatment. Bangor debate goes national Bangor city officials were not pleased when they read in the paper that Acadia Hospital, at the state's request, had applied for a license to open a methadone clinic. While the city has enjoyed a good relationship with Eastern Maine Healthcare and Acadia Hospital, city officials were clearly put out that Acadia staff did not inform them of their plans. What transpired quickly became more of a power struggle over siting a methadone clinic, than a debate over the effectiveness of the drug and related treatment programs. Talks between the city and the state were initiated, then brokedown. Plans to put together a task force to research the pros and cons of a clinic in Bangor failed when the state and city could not agree on its membership. Press conferences were called, city resolutions were passed and often the "debate" stopped just short of name calling. A national methadone watchdog group picked up on the controversy and posted local newspaper articles on its Web page. It also called for action by methadone proponents. "It's a life or death situation in Bangor, Maine, as local residents fight to keep a methadone clinic out of their town. Myths about methadone maintenance is the rule not the exception in this town," states theWeb site. It further calls upon proponents to "bombard" the NEWS with letters supporting methadone treatment. Many did, and letters and e-mails poured into the paper, most to tout the benefits of methadone maintenance. After two very long and well-attended public hearings, a committee - made up equally of city and Acadia appointees - is now researching methadone treatment and is expected to make recommendations by December to the state Department of Mental Health, Retardation and Substance Abuse Services, the state agency governing methadone clinics. In the meantime, however, the city council at its Sept. 13 meeting is expected to decide whether to put the methadone clinic issue before voters in a nonbinding referendum this November. A "citizens' group" has requested the referendum, which would be strictly advisory, serving only to show Acadia and the state how people in Bangor feel about having a clinic in the city. Early in the summer, the Office of Substance Abuse agreed to delay the clinic opening until Jan. 1, 2001, so the community could become more educated. It was a step they did not have to take. No Legal Recourse Legally, the city has little ornothing to say about whether a methadone clinic opens. Clinics are licensed and regulated at the state and federal levels. Cities around the country that have tried to fight clinics have been largely unsuccessful. Most recently, the city of Covington, Ky., lost its battle in federal court to keep a clinic from opening there. The city first tried to keep the clinic out by changing zoning that would prevent the clinic opening near a school. In an important decision, U.S. District Court Judge William O. Bertelsmen found that the city violated the Americans with Disabilities Act when it changed its zoning. That means such clinics can go any place a physician's office could go, and must be judged by the same standards. The decision helps establish a precedent in a relatively new area of law that touches on both the ADA and zoning laws. In Antioch, Calif., the city sought a court order that would prevent a clinic from opening there until the court case between the city and the clinic operators could be settled. The judge denied the request and construction began. Opposition to clinics is not new, and it has not stopped 900 such clinics from opening around the country. The Office of Substance Abuse and officials at Acadia Hospital say the need for methadone treatment is great in Bangor, and that a clinic is essential. Chances are that, barring any licensing problems, a clinic will open sometime next year, despite the intense opposition. Addicts' Best Chance To date, methadone treatment is considered the best chance that opiate addicts have of beating their addiction. Federal laws governing methadone prevent physicians from prescribing methadone for addiction. They are allowed to prescribe it for pain. But that may be changing. In July, the House approved legislation that would make it easier for office-based physicians to use federally controlled substances to treat patients addicted to heroin and other opiates. The bill is intended to make it easier for physicians to dispense buprenorphine, an alternative to methadone in treating opiate addiction. The FDA is expected to approve buprenorphine in the near future. According to a report from the House Commerce Committee,which approved the bill last October, buprenorphine, particularly in combination with the drug naloxone, has been found not only to be effective in helping opiate addicts, but to have a far lower potential for abuse than methadone. Allowing physicians to dispense such drugs would be a positive step, especially in rural Maine, where patients must often drive three or four hours daily to receive their methadone. There are concerns, however, that buprenorphine will cost up to 10 times as much as methadone, therefore putting it out of reach for many addicts. Meanwhile there is only methadone, and it is available in Maine only through clinics in South Portland and Winslow for now. - --- MAP posted-by: Richard Lake