WASHINGTON COUNTY : Drug clinic state’s 3rd
Posted on Monday, October 22, 2007
Addicts trying to kick dependence on painkillers can avoid long daily commutes now that Northwest Arkansas’ first methadone clinic has quietly set up shop.
Before the Sept. 11 opening of Springdale Treatment Center LLC in Tontitown, opiate-dependent patients taking methadone therapy had to travel to Tulsa, Little Rock, Roland, Okla., or Springfield.
The Tontitown methadone clinic is the third in the state, said Garland “Sonny” Ferguson, director of treatment services for the state’s Office of Alcohol and Drug Abuse Prevention.
New methadone patients must get dosing therapy in a clinic setting six days a week for the first 90 days or more of treatment, because of strict state and federal drug regulations.
Methadone treatment and maintenance clinics focus on addictions to a class of narcotic drugs known as opioids, which include natural or synthetic opiates such as morphine, OxyContin and other forms of oxycodone, heroin and hydrocodone.
Ferguson and others say the public’s perception of the typical opioid user has contributed to an unwarranted fear of such clinics.
“The stereotype is that these are the dregs of society,” said Dr. Michael J. Mancino, program director for the methadone center at the University of Arkansas for Medical Sciences, the Substance Abuse Treatment Clinic.
“If you saw them on the street or in the mall, you wouldn’t recognize them as a methadone patient,” he said. “They take care of their families, they show up to their jobs.”
Methadone clinics sometimes run in to community resistance, especially when city regulations are strict and numerous or when the clinics seek zoning changes.
In Tontitown, population 2, 030, an employee in the recorder-treasurer’s office said the city issued the clinic a business license earlier this year.
But its presence was news to Mayor Joseph Edgmon.
The mayor said that, perhaps, the city should consider more restrictions on new businesses to prompt advance discussion: “If something like that comes in, I think we should know about it.”
Methadone has been used for decades to help get people off pain medications, Mancino said.
It activates a person’s opiate receptors without providing the high that other painkillers offer, he said. It also alleviates the intense withdrawal symptoms addicts experience.
“They start feeling physically sick, like the worst flu you can ever imagine,” said Reeve Sams, a spokesman for the new Tontitown clinic.
Once the patient takes methadone, “it creates a blockade effect,” Sams said. “So that, if they do go out and shoot heroin or take any opiate pain pill, their receptors are so full that it would take a very large, dangerously life-threatening dose to have any euphoric effect.”
The ultimate goal for methadone treatment is either total “detoxification” from opioids or, if that can’t be managed, long-term methadone therapy — what clinics call “methadone maintenance.”
Methadone has its critics.
If not used carefully, it can be addictive, dangerous or even deadly whether taken for pain management or drug addiction.
In November, the Food and Drug Administration issued a public health advisory after reports of deaths and life-threatening side effects from methadone treatments. The FDA cautioned that patients might not feel the effects of an overdose coming on, citing subtle symptoms such as dangerous heart-beat patterns, or slow or shallow breathing. The agency also said that while methadone relieves pain for four to eight hours, it can linger in the body for up to 59 hours, leading to a toxic buildup.
News accounts also have chronicled fatal overdoses where methadone was used along with other drugs, such as antidepressants.
AVOIDING DEPENDENCE In Arkansas, there’s an assumption that methadone clinics help funnel prescription medications into the hands of unauthorized users — what health officials and law enforcement refer to as “diversion,” Ferguson said. “We found out down here that the diverting is coming, not from the methadone clinics, but from the pain management clinics,” said Ferguson, whose office in Little Rock is part of the Arkansas Department of Human Services’ Division of Behavioral Health. “One thing that’s changed is that so many pain clinics have opened up in the state at large,” he said.
Patients who are prescribed opioids have to exercise care to avoid dependence.
In the short term, the drugs can provide faster pain relief than some other classes of drugs, but they are more difficult to manage because people build up a tolerance.
“It’s easier for the doctor and the patient, oftentimes, to get immediate relief from the opiate medication than it is to explore non-opiate pain management techniques, such as nonnarcotic pain medications, nerve blocks, and so on,” Mancino said.
Because of strict federal and state regulations, methadone clinics issue far less take-home doses for addiction therapy — especially during initial treatments — than a person seeking pain relief can get from a physician.
For instance, Mancino has observed that, in several fatal methadone overdose cases in Arkansas involving teenagers, methadone clinics were not the source.
“There is far more methadone that’s coming from the person that’s having chronic pain that goes to his doctor and gets a month’s supply,” he said. “Methadone is dirt cheap.”
Donald L. Hickman is a diversion investigator for the U. S. Drug Enforcement’s Administration New Orleans Field Division, which covers a four-state area including Arkansas.
Doctors, clinics and pharmacies that handle controlled substances must first obtain a DEA registration, he said, and applicants undergo a preregistration investigation, including inspection of the site to verify that it meets the federal code of regulations regarding security and alarm systems.
A clinic also must get clearance from the U. S. Department of Health and Human Services’ Centers for Substance Abuse Treatment and any state approvals. In Arkansas, they must get a license from Ferguson’s office. Without the numerous regulations, methadone clinics could end up being merely a place to get a fix, he said: “You don’t want to become a ‘dosing’ clinic.”
BATTLE FOR APPROVAL Ferguson can recall a few failed efforts to open a methadone clinic in Northwest Arkansas. A group tried a couple of times last year to open a clinic, but its application didn’t clear state and federal hurdles. About four years ago, a group approached Ferguson’s office about the possibility of applying, but decided there wasn’t enough clientele. “It takes at least 50 clients for a program to break even,” Ferguson said.
Sams, development and operations director for Springdale Treatment Center and its corporate owner, Riverwood Group LLC of St. Helena Island, S. C., said the clinic gained approval for its operating license from the state on May 17. The Tontitown methadone clinic received its DEA registration on Aug. 27, and its Health and Human Services approval on Sept. 10, the day before it opened. The center was named for its Springdale mailing address, 1400 Meeshow Drive, although it is in Tontitown about two blocks from the Springdale city line.
The clinic is approved for 300 patients, said Sams, who wouldn’t reveal its number of patrons. Dr. Tom Atkinson is the clinic’s medical director, and Jeff Glover is the program director.
Its hours are 5: 30 a. m. to 2 p. m. weekdays and 7-11 a. m. Saturdays. A daily fee of $ 12 covers drugs, counseling, lab work and other costs; there’s also a $ 40 annual fee.
The clinic also is cleared to use buprenorphine, a synthetic opiate used for patients in the early phases of addiction, Ferguson said.
In December, President Bush signed into law the Levin Amendment, which more than tripled limits on the number of patients qualified physicians may treat with buprenorphine. The legislation’s co-author, Sen. Carl Levin, D-Mich., had said doctors and addicts praised buprenorphine as a “miracle drug.”
On average, methadone patients tend to stay in treatment for two years. At each treatment phase, there are numerous requirements, including clean drug screens, a stable home life, weekly attendance at group therapy and individual counseling sessions, acceptable relapse history, and evaluations to determine if the patient can have take-home medication.
The Tontitown clinic has a written referral agreement with Decision Point Inc., said its executive director, Larry Counts. The Springdale- and Bentonville-based drug and alcohol rehabilitation center treats about 1, 200 clients a year.
UAMS’ methadone clinic opened 14 years ago in Little Rock and was followed by a second, private methadone clinic two miles away, Mancino said. The UAMS clinic treats about 160 patients for opioid addiction.
Those who take methadone treatment are far less likely to relapse than those who use a more conventional treatment, Mancino said. The less effective ways include: a 12-step program; traditional detoxification by gradually tapering off the patient’s drug use; and withdrawal combined with other kinds of medications to ease withdrawal symptoms.
For a person who’s been addicted to opioids for about five years, only two in 100 succeed after a year of conventional therapy, Mancino said. That compares with an 80 percent success rate using methadone or buprenorphine.
At Decision Point, Counts tracks trends by classes of drugs.
“Persons identifying opiates as their primary drug of choice, that group has risen in percentage more than any drug we treat,” Counts said. “Over the last five years, we’ve seen the admissions for opiate dependents increase about 8 or 9 percent.” PAINKILLER GLOSSARY Analgesia: The inability to feel pain while conscious. Methadone: A synthetic opioid that can be prescribed to manage pain or to help those addicted to other opioids manage or overcome their dependence. Narcotic drug: A chemical agent that can induce stupor, coma or insensibility to pain. The term usually refers to the narcotic analgesics “opiates” or “opioids.” Opioid: A compound or drug that binds to receptors in the brain involved in the control of pain and other functions inducing analgesia and sometimes euphoria, and in higher doses, stupor, coma and respiratory depression. Opiate: Any of the psychoactive alkaloids that originate from the opium poppy. Some opiates, such as opium, codeine and morphine, are derived from the plant. SOURCES: World Health Organization’s Lexicon of Alcohol and Drug Terms, www. medicinenet. com, National Institutes of Health’s National Institute
on Drug Abuse
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