By Alison Knopf
Opioid treatment programs (OTPs) across the country have been engaged in battles to locate, in the case of new facilities, and to expand, in the case of already existing ones. The problem isn’t with federal regulators, who are mainly supportive of OTPs. Rather, the barriers come from the very communities where treatment is needed. This article will sum up some of the ongoing struggles, as well as some victories.
In Maine, where Gov. Paul LePage has been an outspoken opponent of OTPs—and methadone and buprenorphine—the opioid epidemic is among the worst in the country. Yet even the bullying behavior by the governor is not as significant as local opposition. Colonial Management Group (CMG), based in Orlando, Florida, has been trying to expand its patient capacity in Bangor. The company operates 64 OTPs, with two in Maine—the Penobscot County Metro Treatment Center in Bangor, and another in Rockland.
The Bangor City Council denied the application to treat more patients, and the company, no stranger to legal zoning battles, is considering whether to sue.
Penobscot Metro was seeking to expand the patient capacity from 300 to 500; CMG had recently spent $600,000 preparing for more patients, the Bangor Daily News reported. The state had already approved the expansion. Bangor has three OTPs, with a total 1,500 patients served.
The root of the problem is, as is so often the case, an ordinance. Local approval is required for expansion. The city council of Bangor decided there wasn’t a need for increasing the capacity. Instead, CMG should have opened new facilities elsewhere in Maine, so patients wouldn’t have to travel so far, according to the city council. (Another oddity of the addiction world is that politicians think they know how to treat it—unlike cancer or tooth decay.)
At the root of a possible legal defense, also usually true, is that the ordinance is discriminatory because it singles out patients with addiction, in violation of the Americans with Disabilities Act.
The case is reminiscent of what happened in Warren, Maine, where CRC Health Group (now Acadia) was trying to locate an OTP, and the town enacted an ordinance that restricted the location of OTPs and would have made it impossible for CRC’s site to open. CRC did sue, and the court ruled easily that the ordinance was a violation of the ADA. Warren agreed to settle the case by paying CRC $495,000. The OTP never opened.
This year, following a long legal battle, CMG was paid $350,000 by Monument, Colorado, part of a $900,000 settlement (the remainder to be paid by the town’s insurance agency), according to the Colorado Springs Gazette. The tiny town of Monument used all of its funds to pay the settlement, under which CMG would close its facility and never open again in Monument.
The residents opposing the facility claimed it would attract drug users. Last year, the town denied CMG a business license, and CMG sued. It settled, and is leaving. The victims: patients.
There is also the unsavory scenario of another treatment program contributing to the demise of an OTP. This happened in Louisville, Kentucky, where Baymark was edged out of a building complex by a competing treatment program that not only is not an OTP, but believes that medication should be tapered, not given on a maintenance basis.
BayMark had proposed opening the OTP, but the building owners, Brain Chase and Walter Crutcher, said instead that they would not allow BayMark to rent there. The main opponent of the OTP was Seven Counties Services, which rents 40,000 square feet in the two-story building, the Courier-Journal reported August 19. BayMark would have occupied 7,500 square feet.
This would have been BayMark’s first OTP in Kentucky. In Louisville, there is one OTP, run by the Metro Health Department (1,300 patients), and another, by the proprietary Center for Behavioral Health (300 patients).
Alabama, Tennessee, and More
This summer the Opelika, Alabama city went on record as opposing an OTP there, with the Mayor telling the Opelika-Auburn News, “We don’t want a methadone clinic in Opelika or Auburn, or Lee County.” CMG had filed a certificate of need. A lawyer has now been signed up to represent the city.
In general, Tennessee is not a bright spot in the OTP world. But there is good news. After years of struggling, an OTP in Johnson City is finally near reality. Local citizens had tried to prevent the program from opening.
In West Virginia, there has been a moratorium on new OTPs for years. There is now a moratorium in OTP-friendly Georgia as well, although only for a year. There is only one OTP in Mississippi, where about 100,000 patients cross the border to access care in Louisiana and Alabama. Maryland came close to passing a bill that would require any new OTP to site in an industrial park, away from residential areas.
Prejudice Against OTPs
An oft-repeated criticism of OTPs is that they are “only in it for the profit,” and some people say that OTPs should be allowed to operate only if they are not-for-profit or publicly funded—ironically, these critics are in states that do not have any public funding for OTPs. Even progressive Illinois will start having Medicaid cover OTPs in January 2017, for the first time.
What’s going on? Many OTPs—and patients, including prospective patients, want to know the answer. Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD), told AT Forum that NIMBY (Not In My Back Yard) is the major impediment to OTPs. “It has nothing to do with DATA 2000 (buprenorphine office-based practices) or any federal issues,” he said. “It’s the resistance to increase access to treatment for anyone who needs it.”
Mr. Parrino spoke with Michael Botticelli, director of the Office of National Drug Control Policy (ONDCP) about this—and other issues—recently. Mr. Botticelli’s idea was to conduct a state-by-state inventory identifying all the existing resources used to treat people with opioid use disorders, so that gaps in treatment can be identified.
Mr. Botticelli believes that OTPs are needed in those areas. But how will the OTPs be funded? The data will have to go to proprietary systems that will use them to target the areas of greatest need. On the other hand, there could be broader funding, as Vermont did, with public money to expand treatment.
The adversaries to OTPs, however, can’t be reduced to dollars—not when cities are willing to almost bankrupt themselves to pay to keep an OTP out. The main barriers are stigma and zoning restrictions, and unfounded fear.
And in terms of bordering states, there is the wish that patients would just go elsewhere if they need treatment, with little regard for how many hours patients have to drive.
There is also Stop Stigma Now (http://www.stopstigmanow.org/), which is urging patients and family members to be proud of their recovery, and plans to confront unfounded, erroneous information whenever it appears in print. Unfortunately, the confrontation will have to take place in many city council meetings before it will help OTPs open.