|Pittsfield Residents Get Some Answers on Methadone Clinic|
|By Joe Durwin, Pittsfield Correspondent|
02:55PM / Monday, July 30, 2012
PITTSFIELD, Mass. — Despite frustations over transparency limits created by the city's confidentiality with Spectrum Health Systems, Pittsfield residents had a chance last week to get answers to a number of questions on methadone treatment.
Dr. Jennifer Michaels, medical director of the Brien Center, answered questions about drug addiction and treatment at last week's forum.
The city's been in a yearlong debate over aspects of methadone treatment triggered by the Spectrum's continued attempts to open a clinic in Pittsfield. That prompted a presentation last Monday hosted by the city about methadone and its use.
Following a presentation by a panel of local experts, they and Spectrum Health executives spoke to some commonly asked questions during a question-and-answer hour. Several questions focused on confusion about the nature of methadone treatment itself.
"Why is it that you use a pretty powerful drug to get them off another powerful drug?" asked Pittsfield resident Diane Marcella.
Dr. Jennifer Michaels, medical director of the Brien Center, said the most debilitating aspect of drug addiction was the constant "peaks and valleys" of intoxication and withdrawal. Instead of producing a pleasurable high, methadone acts as a longer-lasting stabilizer that allows an addict to function normally. This sense of normality, Michaels says, "is the exact opposite of active addiction."
Michaels also said attempts to quit opiates cold turkey has very low success rates.
"Studies have shown that when people do that, their relapse rate is over 90 percent," she said. "Also, they're at very high risk of overdosing after they stop using opiates [then relapse]. So opioid replacement therapy, with a long-acting medication, is the treatment of choice for most patients."
One attendee asked why outpatient methadone treatment was not offered as a service by the existing mental health providers.
Both the Brien Center and Berkshire Medical Center have examined this possibility, according to their representatives on the panel, and found it less practical than having a provider who specializes in this treatment and who can partner with them in a way that is complementary to their own programs.
"Starting a program when you've never done one before is very expensive, and there's a huge amount of leg work, with licensure, and training, and we're really not equipped to do it," said Michaels. "There are other agencies that do this frequently, they have it down, and they're in a better place to run a methadone clinic than the Brien Center."
"[Spectrum Health] is a very helpful system which has worked effectively across the state," said Dr. Alex Sabo, head of psychiatry at BMC, "We're looking to work with other organizations, and have Spectrum Health partner with us just like all those organizations have done with the community pain project. We thought this would be the most efficient approach."
Several questions focused on the potential for abuse of the methadone administered at the clinic.
"The medication [administered by Spectrum] is a liquid medication, which is dispensed under the supervision of a nurse, and consumed in front of the nurse," said Spectrum CEO Charles Faris. The dosage is not designed to be taken off site.
Hilary Jacobs, deputy director of the Department of Public Health's Bureau of Substance Abuse Services, said there is a large state and federal regulatory structure around the taking of this medication.
By law, the largest number of doses of methadone a patient could ever be given a prescription for by any medical facility is 13. No patient could qualify for this without at least 18 months of total compliance with program requirements, including passing regular drug screenings and perfect attendance at all treatment and counseling appointments.
The state health official also addressed perceptions that the presence of a methadone clinic leads to an increase in crime, pointing to extensive scientific literature showing the treatment actually leads to crime reduction.
"What you actually see is that people get better in methadone treatment," said Jacobs. "Their physical health improves, their mental health improves, and there are a variety of measures we've used to determine that they've actually improved."
Jacobs said rates of emergency rooms visits as well as arrests go down dramatically for patients in treatment, as opposed to untreated addicts, who may steal to continue supplying themselves with illicit substances. According to the DPH data shown, all but a small percentage of patients in methadone treatment cease being involved in the criminal justice system once they are engaged in the treatment.
Sheriff Thomas Bowler asked Spectrum to speak to concerns from some residents that the clinic would become a focal point of unwanted loitering.
"How are you going to schedule that, so we don't have a venue that has an enormous amount of lower-class people that are addicted hanging around those people's residential areas, or similar places?"
"We stagger our people's participation in the program," said Faris, though most of the patients will receive their medication between 6 and 9 a.m. "This is to accomodate work schedules and child-care issues." Patients return at various times of day for counseling services which are required as part of the program.
"We simply don't tolerate any loitering. We don't mean right in front, or across the street. We mean anywhere in the vicinity," said the Spectrum CEO, who went on to say that this is monitored by specially trained security personnel, with failure to comply as grounds for discontinued treatment.
Others wanted to know if the clinic will become a treatment center for patients from distant locations outside of the Pittsfield area.
Spectrum says about half the patient population it expects to serve lives in Pittsfield, and half from the rest of Berkshire County, pointing to the state Department of Public Health data shown earlier in at the forum.
Those residents of other Berkshire towns would definitely have access to the Pittsfield services. "You cannot restrict the service to a single town or city," said Faris. "Would we be bringing people in from longer distances than that? I can't imagine that. I can't see why we would ever need to do that."
One resident asked the panelists if there was a typical profile of those with addiction, as has frequently been suggested during the clinic debate.
"Addiction to opiates is an equal opportunity disease, in that anyone and everyone is vulnerable," said Michaels. "We know that addiction in general does run in families, that there's a genetic predisposition or vulnerability to become an addict ... Partially it's a genetic disease, and partially it's an environmental disease."
Michaels said that even children who were taken away from drug-addicted parents at birth have been more likely to develop problems themselves, but in addition to the hereditary component, early exposure to a drug also makes addiction to it more likely.
In reference to a recent letter to The Berkshire Eagle suggesting a mobile unit, Spectrum said this would not be possible in this area. "We cannot operate a mobile clinic," said Faris. "People need a stationary site to get counseling."
Despite clarifications on many questions concerning the treatment and its potential impact on the community, several parties voiced continued unease with a lack of transparency about the organization's negotiations with the city and a purported confidentiality agreement between the two.
"I think you're misreading the people of Pittsfield, or the ones that I know. They're not against the clinic, they want to know more about how you determine the location of the clinic," said local radio host William Sturgeon. "And why we have a secrecy agreement that no one can talk about it?"
"I, too, have no issues with this program or your business coming to this community," said Joyce Bernstein, who owns the Spice Dragon restaurant adjacent to Spectrum's first proposed location on Summer Street. "I am not opposed to you coming. I am opposed to the manner in which this is being presented to us."
"There is still a pending federal law suit, that is one of the reasons we can't be specific," said Mayor Daniel Bianchi, deflecting all questions involving locations and the status of the current lawsuit between Spectrum and the city of Pittsfield. "We have a confidentiality agreement. That was agreed to by the last administration, and we can't debate that."
Faris did expand, however, on some of Spectrum's criteria for selecting a site of operation.
"Is it accessible to those who need the services? Is it near public transportation? Is there adequate parking? Is it a facility thats speaks to a dignified environment for treatment? Is it someplace where the whole staff wants to come to, and feels that they're comfortable coming to?"
Spectrum's other five locations in Massachusetts are in areas that contain residential dwellings.
"Our largest site, which is in Worcester, we see roughly a thousand people a day. It is directly next to an elementary school. Literally next to it," said Faris. "You can almost reach out the window and touch the elementary school. We've been there for going on 13 years, and never had an incident.
"We've been at this for about a year and a half now. We don't have a specific date, but we'd certainly like to get closure to this, and get the service instituted in the community as quickly as possible," he continued.
Furthermore, the Spectrum executive said, any advance announcement plans to the community will depend on the outcome of the current litigation with the city.
Some expressed dissatisfaction with the fact that the public would not be able to have more information or input on the ultimate location of the proposed clinic.
But Bianchi reminded residents repeatedly throughout the forum that "a business that is licensed, and is appropriately zoned, can operate, and the community cannot dictate — the mayor, the City Council, the city solicitor, cannot say 'You cannot be in one place or another.'"