NIMBY and Other Problems: Still an Uphill Battle For OTPs, But Hope Seen In Patient Advocacy

advocacyThe NIMBY (Not In My Back Yard) syndrome is one significant challenge for opioid treatment programs (OTPs), which can’t operate if they can’t get approval from municipalities. Methadone maintenance treatment has been proven effective and producing good outcomes for five decades, but that isn’t preventing politicians from pandering to prejudice and discrimination. Still, the field is forging ahead, opening new programs and providing access to treatment to needy patients.

Sally Friedman, legal director with the Legal Action Center, said that local authorities often try to zone out drug and alcohol programs in general, but it’s even more difficult to site a methadone program. “It’s challenging to site any type of facility that serves people who folks don’t want around,” she said. “I’ve seen this from examining case law—there’s NIMBY for everything, the elderly, group homes, communities want to keep out all types of social services.”

But a special place in NIMBY-land is reserved for OTPs. In 1977 the Legal Action Center won a landmark discrimination case in which a federal court prevented White Plains in New York from zoning out alcohol and drug abuse treatment programs—and while it wasn’t specific to OTPs, OTPs are included. “Stereotypes and myths” play a part in the NIMBY decisions, said Ms. Friedman.

The Americans with Disabilities Act (ADA) clearly supports OTPs and their patients, and municipalities and their lawyers can easily lose in federal court since the law is so clear. “But there’s a lot of political calculation,” said Ms. Friedman. Local politicians think they have more to gain politically from keeping the facility out, so they’re willing to risk the lawsuit and let the court tell them what they have to do.

MAT First

One point that the substance abuse treatment field in general needs to make more strongly is that medication is the first-line evidence-supported treatment for opioid addiction. “Myth and misunderstanding continue to plague not just methadone alone but medication-assisted treatment [MAT] in general,” said Michal Botticelli, deputy director of the White House Office of National Drug Control Policy [ONDCP]. For opioid dependence in particular, medication is the “first line in our arsenal,” he said. “We have to make sure people understand that this is the standard of care.”

Mr. Botticelli added that there is an opportunity to create a greater consumer voice in favor of MAT. “People have done exceedingly well on methadone maintenance.” Some people need more than medication—other social supports and the structure of an OTP—but others don’t.

As states continue to express concern about prescription drug abuse and overdoses, mainly surrounding opioids, the ONDCP is increasing its stress on the importance of access to methadone and buprenorphine, as well as social supports provided in an OTP. “If we really want to deal with overdose deaths, we need to make sure that we have adequate access to MAT.”

The same myths and stereotypes that bolster NIMBY apply to the criminal justice system, which routinely denies access to medication-assisted treatment. The biggest myth is the one that methadone and buprenorphine are “substituting one addiction for another,” which couldn’t be farther from the truth. Patients in MAT are not addicted—they are not pursuing drugs, they are in recovery, employed, productive members of society. But proponents of discrimination don’t understand how the medications work.

Lack of Negative Impact

It’s also easy to demonstrate the lack of a negative impact in NIMBY siting cases. Jerry Rhodes, chief operating officer of CRC Health Group, said it’s important to bring out studies that show crime goes down when clinics are deployed. “There is science that shows methadone treatment has good results,” he said. But here’s the problem: the issue is an emotional, not a logical, one.

The studies showing that methadone works have been ignored by many public policy makers. And while OTPs had been hoping to enlist government officials and regulators in support of MAT, that isn’t working either. “We’ve had the rug pulled out from under us,” said Mr. Rhodes. “We’re trying to get a more robust commitment.” 

Support From Patients

One thing OTPs could do better is to involve the support of patients, said Mr. Rhodes. “There are often compelling personal stories around the need for treatment, and the effectiveness of MAT.”

In general, the OTP field has done a poor job of rallying patients. But Mr. Rhodes understands that it’s hard to get patients to come forward. “You could lose your job, your neighbor could say something, there’s a fear of being seen as a patient in a clinic.”

The field is beginning to recognize that OTP patients, like other people in recovery, can be a significant voting bloc. For example, there are 5,000 to 6,000 OTP patients in West Virginia. In a small state like West Virginia, 5,000 votes—in some places, even 1,000 votes—can swing an election. When there is no access to MAT, patients—and prospective patients, who also vote—suffer. “This is a job for the National Alliance for Medication Assisted Recovery  (NAMA),” Mr. Rhodes said.

Collaboration

Another good advocacy tactic involves collaborating with other groups. Mr. Rhodes cited the effectiveness of the autism advocacy movement, which is spearheaded by parents who are fierce advocates for their children. Drug addicts, alcoholics, people with mental illness need the same kind of advocates, but have always been treated as marginal populations, which is what drives the stigma. “We can do a better job of working with other constituents,” he said.

Even as a field, various types of treatment are fragmented—medication, no medication, alcohol, drugs—and OTPs could benefit by these groups working together and bringing OTPs into the tent.

Back to NIMBY

The bottom line is, OTPs need facilities, and that means they need certificates of occupancy. Mr. Rhodes warns clinics against going into a community to develop a clinic and not garnering support first. “You can’t do this and not deal with NIMBY, but you can do a better job of trying to support these efforts.”

Here are some of the things you can expect to hear when you try to site a program. “This isn’t our problem.” That’s pretty easy to refute, because an OTP usually has done research and knows that there is an opioid problem. For example, at one meeting, someone stood up and said, “I don’t want this town becoming a methadone mecca.” A physician who was there then said, “You don’t understand, this town is already a heroin mecca.”

The OD Bandwagon

Despite the many newspaper articles about prescription opioid abuse and overdoses, there are rarely any discussions of the cure—treatment. “People don’t understand how prescription opioid abuse relates to methadone treatment,” said Mr. Rhodes. “We rarely address the cure, we just talk about the magnitude of the problem.”

“Education is key,” agreed Ms. Friedman. “We need to explain how the disease works, how the treatments work, and how we produce successful outcomes.”

Bob Newman is Retiring, But You Haven’t Heard the Last From Him

BobNewmanphotoLegendary methadone treatment advocate Robert G. Newman, MD, is retiring. But, he hastens to add, he is not leaving the field. “What I’m leaving,” he told AT Forum in February, “is the office.”

Dr. Newman announced via a January 26 e-mail that he would be giving up his “formal role” as director of Beth Israel’s Baron Edmond de Rothschild Chemical Dependency Institute. He will continue to work through June, but Hindy Bernstein, his assistant of the past 25 years, will be leaving in April. “Hindy is leaving me for Florida,” he said. Although he will no longer have the financial support of Beth Israel, he will continue advocacy efforts.

An Advocate

“The challenges are at least as great today as they were 40 years ago when I started my advocacy work,” Dr. Newman said. He will continue to be a fly in the ointment, but he does want to see more “noise” from the rest of the opioid treatment program (OTP) community.

His days will continue to begin and end the way they have for years, he told AT Forum. “I go to the Internet, I get the Google alerts, which very often have some particularly horrendous feature that I’m obliged to respond to.”

There is a lot of “bad news” for Dr. Newman to blog, write letters to the editor, and send e-mails about. And he does so very articulately. For example, some states are cutting off methadone treatment arbitrarily, trying to limit it to one or two years. Regulators are confounding addiction and dependence, not recognizing that maintenance medication is treatment, not a “substitute” for heroin. Unbelievable as it is that this non-science is going on today, some 50 years after medication-assisted treatment (MAT) has been proven effective, and in the face of federal officials, Dr. Newman sees it happening. And he isn’t going to be quiet about it.

NIMBY

NIMBY—the “not in my back yard” phenomenon in which even people who claim to support MAT don’t want programs in their neighborhoods—is illegal, violating the Americans with Disabilities Act (ADA). But despite the various ADA wins that OTPs have achieved, they are never “precedent-setting,” and therefore need to be fought over and over again. “This is terribly frustrating to me,” said Dr. Newman.

Dr. Newman said the opioid-treatment field can help with this fight. “There are many reasons for NIMBY, and some of those reasons have to do with the field, how we have allowed our treatment, our patients, our services to be viewed,” he said. “It isn’t just misperception on the part of communities and politicians. Some of the anti-methadone- patient bias reflects the way the field has chosen to isolate itself and adopt and embrace unique practices that make this treatment separate.”

 Office-based Methadone

 Dr. Newman is glad that buprenorphine has been made available to OTPs and to office-based opioid treatment (OBOT) providers, as a treatment tool for caring for opioid dependence. He notes that more than 40 years ago he proposed that private physicians be permitted to offer methadone maintenance, in addition to OTPs. And now that buprenorphine can be utilized in OBOT, why not methadone, he asks rhetorically. Dr. Newman also notes the extremely limited willingness of office-based physicians to become “waivered” to prescribe buprenorphine. “I think some of the practices of programs are so foreign to what is done in every other field of medicine that medical colleagues view this as something that is from Mars and refuse to get involved in any form of opioid-dependence treatment.”

In fact, the requirement that patients go to a clinic every day is a barrier to care. Dr. Newman is skeptical about the effect of the Affordable Care Act (ACA) on OTPs in particular. “I have seen repeated references to the notion that under the ACA, there’s going to be a sudden upsurge of demand for addiction treatment,” he said. “Increased demand, maybe,” he said. “But how is that demand going to be met? You can have all the insurance you want, but an awful lot of people who need treatment will avoid OTPs because of the requirements and the stigma, and there are not that many OBOT providers.”

Nevertheless, he noted that hundreds of thousands of patients do go to OTPs for MAT, which shows how motivated these patients are. “How many people would have the motivation to deal with obesity, smoking, hypertension, or a great many other medical problems if the treatment regimen required many months of daily attendance and a host of other demands? The fact that there are 300,000 people enrolled in MAT is amazing.”

 Methadone Safety and Dosing

With an appropriate dosage schedule, methadone is an extremely safe medication, said Dr. Newman. But he warned that some OTPs give induction increments that are too great. The federal regulations state that the dose on the starting day must not be more than 40 milligrams—the first dose has to be no more than 30, and an additional dose that day can be 10, said Dr. Newman. But after that, there are some programs that raise the dose too quickly. “Some programs have induction protocols of 30, 40, 50, 60, 70,” with the dose going up daily, he said. The rule of thumb—“start low, go slow, aim high”—needs more of an emphasis on “go slow.”

 Federal Exclusions

Finally, Dr. Newman would like to see more support for methadone treatment at the federal level. The insurance plans of the federal Department of Veterans Affairs and the Department of Defense have an exclusion against methadone and buprenorphine maintenance treatment, something Dr. Newman has long railed against. “Tom McLellan (then deputy director of the federal Office of National Drug Control Policy) and other very high-level officials have said the exclusion is bad, and that they were trying to change it,” said Dr. Newman. “But it persists, and that’s inexcusable and shameful. “

What Dr. Newman wants advocates to do is to speak up. “Silence equals death,” he said, citing an oft-used slogan of AIDS activists years ago. And he is not going to be silent. “There are a lot of windmills still out there.”

OTP Victory in Berwyn Hoped to Discourage Other Localities From Discriminating

The city of Berwyn, Illinois will never pick a fight with an opioid treatment program (OTP) again. In July, it settled with Elizabeth Buonauro and Sal Sottile, current owners of an OTP in Evanston, Illinois that will now be allowed to open a second clinic in Berwyn, for $650,000. The saga is one of discrimination against methadone patients, of the illegality of that discrimination, and of the foolhardiness of localities in persisting in that discrimination to the point of fiscal irresponsibility. At the root of that foolhardiness is the craven fear of politicians that they will lose their jobs if they don’t do what voters want—even if they know the voters are wrong.

The Berwyn City Council first voted in 2008 to allow the clinic to open in a medical building, but NIMBY (Not In My Back Yard) -ism soon crept in, with residents opposing it. The City Council reversed their decision. In November of 2008, the clinic’s owners sued the city.

The Americans with Disabilities Act (ADA) is a powerful ally of OTPs. When authorities so obviously target people in treatment for drug addiction—a specifically protected class under the federal law—they really have no defense, and if they are taken to court, they inevitably lose. This was seen last year in Warren, Maine, when CRC Health Group won its battle for an OTP there, and the town’s insurance company had to pay $320,000.

“The court’s decision that the City of Berwyn violated federal anti-discrimination laws is the latest of a string of federal court decisions holding that zoning out methadone programs violates federal law,” said Sally Friedman, legal director of the Legal Action Center. “What’s striking about this case is the substantial $650,000 settlement.  This large sum of money should awaken other municipalities to the fact that that discrimination is costly, as well as illegal.”

Between its first vote and the second, Berwyn Council members were pressured by residents to keep the OTP from opening. Knowing that a lawsuit was possible, and that the city had no legal grounds to stand on, the Berwyn Council members nevertheless gave in to residents, who said that the OTP would lower their property values and bring crime into the neighborhood. In April of 2011, the city denied the clinic a business license, even though it had passed all zoning requirements.

The Ruling

The ruling by Judge Sharon Johnson Coleman of U.S. District Court on May 11 held that Berwyn violated the ADA when it passed an ordinance banning OTPs. The ordinance was illegal, because of “the city’s ongoing discriminatory intent in the zoning decisions,” Judge Coleman noted.

“Federal courts have consistently held that a municipality violates the [ADA] by subjecting a substance abuse clinic to differential zoning treatment because of its association with individuals recovering from an addiction. There is ample evidence that Berwyn’s zoning decisions regarding the plaintiffs’ clinic were motivated by an intent to treat its clients differently from other medical patients.”

Key to the case was a video tape in 2008 in which city aldermen clearly perceived that they might lose their seats if they voted for the clinic. “The reactions of (Fourth Ward Alderman) Michele Skryd, (then-Seventh Ward Alderman and now Mayor) Robert Lovero, and (First Ward Alderman) Nona Chapman to the community’s hostility towards the clinic in 2008 are evidence of a perceived voter animus so strong that it could only be ignored at the council’s political peril in later years,” Judge Coleman wrote.

The judge ordered that Berwyn pay the OTP’s legal fees, issue a business license, and not block the clinic with any zoning changes.

But as of September 4 Ms. Buonauro still did not have a business license – Berwyn was stalling, even though the judge said to “immediately” grant the license, she said. “I pay the lease but I don’t have a key, I don’t want the liability,” she said. “I’m not going to do a buildout and have Berwyn do something else to me.”

It was a long 4 ½ years, and now there is a victory, but the battle isn’t over for Ms. Buonauro. “They talk about NIMBY,” she told AT Forum. “This is my back yard. I live within 2 blocks.” However, she proudly describes the facility is perfect,–the second story of a bank building, with a rear entrance for privacy for patients, and other medical offices in the building.

Judge Coleman also said that ordinances and zoning rules designed to keep OTPs out of municipalities are illegal, a ruling that will hold for much of Illinois. (The ruling, while in federal court, applies only in the district that it covered.) “A zoning provision that discriminates against methadone clinics violates the ADA even if it merely provides a location restriction rather than an outright ban, and even if the provisions offer a process for relief from that restriction,” the ruling stated.

The decision to settle the lawsuit was made in a 4-3 vote.

Now that there is no chance of a legal appeal by Berwyn, they are finally ready to open their new facility.  It was unclear at press time how many patients the facility would have or when it would open. “Another program might have given up in the face of the opposition,” said Richard Weisskopf, State Opioid Treatment Authority for Illinois, in an e-mail to AT Forum. “Not Ms. Buonauro!” But it was abundantly clear that where other programs might have given up in the face of the opposition, Liz Buonauro would not. And this perseverance paid off, for herself and her patients.

Stop Stigma Now: Small Organization Rises to Raise Funds for Methadone Treatment PR Campaign

 Stop Stigma Now, a small group of retired opioid treatment program (OTP) providers has a big—and honorable—goal: eradicating stigma against the methadone treatment field. It began about five years ago with the closure of the Mount Sinai Narcotics Rehabilitation Center in New York City, recalls Joycelyn Woods, project coordinator with the National Alliance for Medication Assisted Recovery (NAMA Recovery).

The physician and administrator who led that program got together and started talking about the fact that the stigma situation isn’t any better than it was in 2007. “It’s worse,” said Ms. Woods. “Nobody is going to do anything about it unless we do something about it ourselves. I had hoped for a long time that the federal government would do it—they have the money and the resources.”

Sy Demsky, the former administrator at Mount Sinai (he retired shortly before the closure), and Philip Paris, MD, the physician, helped organize the Stop Stigma Now group. “Their idea is to raise money from new sources and create a huge PR campaign,” said Ms. Woods. One suggested way of raising money was to ask OTP patients—each of whom would contribute one dollar. “The programs have to decide whether to cooperate. This could be impossible to manage,” she said.

This leaves Stop Stigma Now in a difficult position—doing something very important, without adequate funding to make it happen.  With prescription opioid abuse rampant, OTPs and state substance abuse agencies seeking to address this are faced with new zoning restrictions or outright prohibition based on prejudice or unfounded fears.

“We wish to let the public see our patients as the successes so many of them are,” Dr. Paris told AT Forum in an e-mail. “Our patients are dependent on their medication, not addicted,” he said. “They are not substituting methadone for their street drug. Instead, methadone helps to correct the illness induced by years of using heroin or abusing pain medications.”

Stop Stigma Now attended the AATOD conference in Las Vegas, prominently passing out buttons and letting the addiction treatment field know about their work. “We were received warmly with a show of support by many of the leaders in the field,” said Dr. Paris. “We received many pledges for future financial support. That is very important if we are to be able to widen our anti-stigma message.”

To find out more about Stop Stigma Now, and to make a donation, go to http://www.methadone.org/stopstigmanow/.

Link accessed May 27, 2012

New Study: Methadone Clinics Don’t Bring Crime to Neighborhoods


The NIMBY (“not in my backyard”) people are at it again. But a new study refutes their claims and shows that methadone clinics don’t attract crime.

The Good News

Crime Rates Aren’t Higher Around Methadone Clinics

In a well-designed study published online in Addiction, March 2, 2012 ahead of print, investigators compared data from a computer listing of all FBI reports of serious crimes, such as robbery, homicide, and sexual assault, in specific areas of Baltimore. The areas included 13 methadone treatment centers and three types of control locations: 13 convenience stores, 13 residential points, and 10 general medical hospitals.  The study team found no significant increase in crime around methadone treatment centers (MTCs) or general hospitals. (The study period was January 1, 1999 through December 31, 2001.  After collecting the data, the team spent several years developing the technology and analyzing the data before publishing the article.)

And—here’s something very interesting—investigators did find significantly higher crime counts close to convenience stores. Bottom line: Methadone clinic neighborhoods, unlike those of convenience stores, are not associated with a higher crime rate.

The authors note, ”Our finding that MTCs are not associated with increases in neighborhood crime addresses a major impediment to the establishment of new clinics, and should lead to greater availability of methadone maintenance treatment for the many persons who need it.”

Let’s hope the NIMBYs are paying attention.

Reference: Boyd SJ, Fang LJ, Medoff DR, Dixon LB, Gorelick DA. Use of a “microecologic technique” to study crime incidents around methadone maintenance treatment centers [published online ahead of print March 2, 2012].  Addiction.  doi: 10.1111/j.1360-0443.2012.03872.x. 

But Emotional Protests Persist

From Orange County, Florida: a methadone clinic that opened last month is the latest in a string of establishments “bringing crime to the neighborhood,” some residents complain. Locals told WFTV’s Drew Petrimoulx that pain clinics and pharmacies moving into the area are “attracting the wrong kind of people.” “There’s a lot more vagrancy.” A resident gave WFTV a photo of two people passed out at a bus stop; she said the pair had just left the new methadone clinic.

It’s not as if this was an elite section of Orange County to begin with. In fact, one resident asked why the neighborhood was picked for a new methadone clinic when the area already had so many problems. 

Readers responding on the WFTV website echoed that opinion:

“Don’t make me laugh. That area has been horrible for a decade or more.”

“That area has been called heroin run for many years.”

“ . . . one is a fool to go near there.”

(http://www.wftv.com/news/news/neighbors-say-methadone-clinic-bringing-crime/nLPyN/).

Another From Somers Point, New Jersey: Fear gripped residents when an 89-year-old woman was attacked and sexually assaulted in her home. A suspect was arrested, and the incident apparently is totally unrelated to the local methadone clinic that has been operating for 10 years. But that hasn’t calmed people. They’re upset and angry about the clinic. Staff writer Christopher Ramirez said residents are “fed up with problems in their neighborhood and are placing blame for recurring issues on a methadone clinic directly across from their homes.”

The City Council got creative and found a novel way to spur the methadone clinic to move: it introduced an ordinance to prohibit parking on the street bordering the clinic.

(http://www.pressofatlanticcity.com/news/top_three/article_68980e70-bee0-11df-be4a-001cc4c03286.html.)

And lastly from Salem, Florida: the Zoning Board of Appeals last month unanimously rejected a permit request for a methadone clinic. SalemPatch.com says Community Substance Abuse Centers (CSAC) plans to appeal, raising alarm among residents.

The ZBA’s stated reasons for rejection: traffic concerns and the residential character of the area, which includes Witchcraft Heights. [The Salem name is linked with a rumored ghost population; some say Salem is “bursting with struggling spirits just waiting to spook you.” Maybe that’s part of the problem. www.ghostsofamerica.com.]

Any evidence of a rise in crime around existing clinics? Not that Salem Police Chief Paul Tucker is aware of. He should know, and he supports having a methadone clinic in Salem.

http://salem.patch.com/articles/area-police-chiefs-meth-clinics-dont-up-crime

Sometimes Good Sense Prevails

As reported on the AT Forum website last November, a Warren, Maine methadone clinic won a NIMBY battle after a yearlong fight. Education, mediation, and lawsuit considerations triumphed over a classic NIMBY response based on emotions, and the community finally granted permits for an opioid treatment program.

http://atforum.com/news/2011/11/methadone-clinic-wins-nimby-battle/OTP Patients

(All sites accessed March 30, 2012.)

 Tell us about your OTP NIMBY experiences and how you overcame them. You
 can post your comments by clicking the comment link at the top of this page.

 

Manhattan Law Would Force City to Alert Neighbors on Methadone Clinic Openings

New legislation has been proposed that would require the city to notify local community boards of plans to open methadone clinics in the wake of a failed attempt to bring a clinic to lower Manhattan last year.

The bill Councilwoman Margaret Chin is set to introduce would force the city’s Health Department to contact community boards and the City Council about any plans to open methadone clinics when the department is first contacted by the state Office of Alcohol and Substance Abuse Services for certification.

http://www.dnainfo.com/20120313/manhattan/new-law-would-force-city-alert-neighbors-on-methadone-clinic-openings

Source: – DNAINFO.com – March 13, 2013

LOCAL NEWS OF INTEREST

Florida

Florida goes from “Oxy-Express” to anti-prescription drug abuse leader – 3/14/12

One year after Florida launched its pill mill strike force teams, state leaders say Florida has gone from being known as the “Oxy-Express” to a role model for the nation on how to crack down on prescription drug abuse.

On Wednesday, Gov. Rick Scott reported that prescription drug strike force teams have removed about a half million pills from the streets and made more than 2,000 arrests, including 34 doctors in the past year.

http://www.wtsp.com/news/article/244707/19/Florida-goes-from-Oxy-Express-to-anti-prescription-drug-abuse-leader

New York

Law Would Force New York City to Alert Neighbors on Methadone Clinic Openings – 3/13/12

New legislation has been proposed that would require the city to notify local community boards of plans to open methadone clinics in the wake of a failed attempt to bring a clinic to lower Manhattan last year.

The bill Councilwoman Margaret Chin is set to introduce would force the city’s Health Department to contact community boards and the City Council about any plans to open methadone clinics when the department is first contacted by the state Office of Alcohol and Substance Abuse Services for certification.

http://www.dnainfo.com/20120313/manhattan/new-law-would-force-city-alert-neighbors-on-methadone-clinic-openings

Oklahoma

Addiction costs Oklahoma more than annual budget – 3/10/12

  • Addiction costs Oklahoma and its residents an estimated $7.2 billion a year.
  • That’s more than the state government’s budget of $6.7 billion.
  • That’s roughly $1,900 for every man, woman and child in the state. Enough to create about 273,000 median-wage jobs. Enough to build nine skyscrapers like Oklahoma City’s Devon tower.

http://www.tulsaworld.com/news/article.aspx?subjectid=702&articleid=20120310_11_A1_Adcinc365593

New York Bill Introduced on Methadone Clinic Location Restrictions

On January 27 the state of New York introduced an ACT to amend the mental hygiene law, in relation to the location of methadone treatment centers. The ACT would prohibit the establishment or continued operation of a methadone clinic within five hundred feet of an educational institution at the secondary level or below, day care center, park, church, synagogue or other place of worship unless located within a hospital.

http://assembly.state.ny.us/leg/?sh=printbill&bn=A09145&term=2011

Source: State of New York Assembly – January 27, 2012

NIMBY: Stack, Boyle Bills Toughen Regulations for Proposed Methadone Clinics in Pennsylvania

Standing outside the site of a controversial, proposed methadone treatment facility in the Holmesburg community of Northeast Philadelphia, state Sen. Mike Stack and state Rep. Kevin Boyle announced October 13th their legislation that would tighten loose regulations currently in place for these facilities.

“We as a community were recently blindsided by the Healing Way’s plans to open a methadone clinic here. Fortunately, we have very active citizens who took action when we learned the truth,” said Stack (D-5th dist.). “The public deserves adequate notice and a chance to respond when a drug treatment center wants to open a facility in their community, and our legislation gives residents a voice in the approval process.”

“The proposed facility in my district would have a significant impact on the neighborhood. Many community leaders and residents have come together to fight against the proposed clinic,” said Boyle (D-172nd dist.). “This legislation would provide the tools necessary to fight back against such a situation happening elsewhere in Philadelphia and across the state.”

Stack’s legislation (Senate Bill 1277) and Boyle’s identical legislation (House Bill 1885) include four key provisions that the lawmakers say will ensure community involvement when a clinic is proposed:

  • They would require a public hearing for all proposed narcotics treatment facilities. Written notices would be given out 30 days prior to the hearing to all property owners or lessees located within 500 feet of the proposed facility.
  • The owner of the proposed facility would be required to receive approval from the local district attorney.
  • The proposed facility would be required to have adequate parking before it could be approved by the Department of Health.
  • The Department of Health would provide written notice to all locally elected public officials at the city, state and federal level of the location immediately upon receipt of the application. Notice would also be given to the Single County Authorities, which is the agency responsible for providing drug and alcohol addiction treatment to Pennsylvanians who have government-sponsored health coverage.

The bills were drafted in response to a recent dispute between the community and the Healing Way, which wants to open a methadone treatment facility at 7900 Frankford Ave.

Residents and nearby businesses claim they were told Healing Way was opening a doctor’s office or medical facility, not a methadone treatment center. They claim there was insufficient notice to file a petition opposing it to the Zoning Board of Adjustment.

Philadelphia Councilwoman Joan L. Krajewski (D-6th dist.) said her office investigated the property and found that a permit was obtained through the Department of Licenses and Inspections “over the counter,” meaning the applicant applied for it in person at L&I headquarters in downtown Philadelphia and received it without having to post a zoning notice or make the surrounding residents aware.

Krajewski hired an attorney and appealed the permit, funding both the appeals court fee and rented buses for community members to attend the hearing in opposition.

Krajewski applauded the Holmesburg Civic Association and surrounding residents for jumping into action when word of a proposed methadone clinic circulated the neighborhoods.

“A methadone clinic does not belong in such a heavy populated area, it should not operate so close to houses and local retail businesses that make up our Frankford Avenue corridor,” said Krajewski. “Our constituents of Mayfair and Holmesburg and any other residential neighborhood for that matter do not want this in their backyard. It belongs in a hospital facility setting.”

“The community has legitimate concerns with the Healing Way, including its proximity to an elementary school, daycare and church and the lack of parking. They were most concerned, however, that the Healing Way did not reveal its true intensions,” Stack said. “The community should have direct input. Our legislation accomplishes that.”

“When you look at the facts, it is clear that 7900 Frankford Avenue is not a good location for a methadone clinic, and the public should have been given the opportunity to address those concerns,” Boyle said.

http://www.senatorstack.com/media/releases/2011/Oct13.htm

Source: Pennsylvania State Senator Mike Stack – October 13, 2011

Methadone Clinic Wins NIMBY Battle

A victory in Warren, Maine for CRC Health Group is a victory for methadone clinics seeking sites across the country. It also means that a community that was staunchly opposed to a methadone clinic will have the chance to see how an opioid treatment program (OTP) can operate as a good neighbor. After a yearlong battle, the town voted to settle a lawsuit filed by the Cupertino, California-based treatment program—and to grant permits and approvals for an OTP there.

The lawsuit also asked the town for $320,000. In September, the town voted to settle the lawsuit for what ended up being only $1—and for the right to operate a methadone clinic. The town’s insurer paid the remainder of the $320,000 to CRC.

Background

Ever since Turning Tide, a methadone clinic in nearby Rockland, was shut down by the Drug Enforcement Administration during the summer of 2010, that area of Maine has been without needed help for people with active addiction to opioids, now a serious epidemic in the state. CRC Health Group tried to open a program in Warren, which is near Rockland, but the town of Warren issued a moratorium on methadone clinics, to block CRC and any others from opening an OTP there.

This was a classic NIMBY (not in my backyard) response, one based on “emotions,” explained Jerry Rhodes, Chief Operating Officer of CRC and past president of its recovery division, speaking to AT Forum in October. But CRC filed suit and won. The company sued based on the Americans with Disabilities Act, which bans discrimination based on disabilities; addiction is a disability. 

Over the course of the past year, CRC officials explained to the town that most of the patients in the OTP would be addicted to prescription drugs and not using needles, and gave scientific presentations on how effective methadone is. The town dug in its heels all through late last year and early this year. CRC’s lawyer wrote a letter to the town last winter warning that if the town did not reinstate the building permit previously given to its methadone program there, and repeal the moratorium, there would be “immense liability” to the town.

One Day of Mediation

“We had to file suit against the city, unfortunately,” Mr. Rhodes said. The resolution came about through mediation. “They came to realize that we were right.” The mediation process did not take a long time, but it was “fairly intense.”

At the August 31 mediation, the town learned that it could be facing two years of costly time in court, and that it would probably lose its case.

In the case of Warren in particular, “it didn’t seem as if they were well-advised, or had thought this out,” Mr. Rhodes commented.

Emotions

The field needs to work harder to educate people about medication-assisted treatment, Mr. Rhodes said. “I’ve done this for a long time, and many people have an emotional, almost visceral, reaction. They don’t have a good understanding of the basis of addiction. People clearly aren’t aware of the gravity of the problems in their own community.”

When people in Maine read the many news stories about the epidemic of prescription opioid abuse in the state, they are somehow not connecting this to the communities they live in. People also need to realize that installing a clinic that provides services for opioid abusers “can be a positive thing for the area,” Mr. Rhodes explained. “Treatment programs reduce crime and help people improve their lives.”

The coming days and weeks will be spent on integrating the clinic into the community, in preparation for the actual opening, said Mr. Rhodes. “I’m not expecting we’ll see any overt negative reaction. Things tend to settle down, and they will realize we’re not the problem they anticipated.”

More NIMBY News

Meanwhile, in Berwyn, Illinois, the Buonauro Clinic is seeking to open a new facility (one already exists in Evanston). Just as in Warren, Maine, the permit was initially granted, and then rescinded after community protests; voters then voted to ban methadone clinics in certain areas. The owners sued the city, claiming it violated the ADA. The lawsuit is seeking $1 million in damages and issuance of a business license.

The suit was filed in U.S. District Court in Chicago by clinic owners Elizabeth Buonauro and Sal R. Sotille.

Evidence was presented at trial in October, with more information to go to the judge over the course of the next couple of months, and a ruling is expected in January.

New York Methadone Clinic Blocked

The director of a methadone treatment trade organization drew a sharp rebuke when he hinted at the possibility of legal action if Glens Falls, New York officials attempt to prevent a methadone treatment center from opening in the city.

Henry Bartlett, executive director of the Committee of Methadone Program Administrators, told the Glens Falls Common Council on Tuesday evening that the city’s lawyers should review previous legal decisions involving the cities of Baltimore, MD, and Reading, PA.

Mr. Bartlett said both decisions centered on the Americans with Disabilities Act and the 14th Amendment to the U.S. Constitution, which addresses equal rights for black people.

http://poststar.com/news/local/methadone-clinic-blocked/article_16113c12-f48b-11e0-850c-001cc4c002e0.html

Source:Glens Falls Post Star – October 12, 2011

Town of Warren Maine Settles Methadone Lawsuit – Insurer to Pick Up All but $1


Warren townspeople voted 97-45 Sept. 14 to settle the federal lawsuit filed by CRC Health Group for $1 from the town’s fund balance with the town’s insurance company picking up the rest of the $320,000 settlement.

About 150 citizens packed the gym at the Warren Community School for the meeting. Residents had come to the meeting expecting to vote on authorizing $180,000 to pay toward the settlement, but town officials and the town attorney revealed that the town’s insurance company had agreed to pay the full settlement amount if the town could agree to it that night and not continue the litigation.

Source: Knox.Villagesoup.com – September 15, 2011

15-Minute Methadone in Baltimore – Police and Public Health vs. the Regulators

Baltimore is on the verge of a showdown over methadone. It’s not the usual NIMBY battle – Baltimore has embraced medication-assisted treatment for opioid addiction since the days of the well-informed and visionary Mayor Kurt Schmoke. Instead, it’s about something called “open-access” methadone, in which someone can come in for a quick assessment and get the medication within 15 minutes.

Waiting lists for treatment in Baltimore, where heroin addiction is a long-time problem, mean that many people are turned away for treatment when they most need it and are most likely to benefit. What are they supposed to do for a month while they are waiting to be admitted? Most go back to their dealers.

Now, one program is vowing to tackle the regulatory apparatus preventing methadone treatment from expanding and is just going to do it – at least that’s what the operator says.  In late June, Rev. Milton Williams, pastor of the New Life Evangelical Baptist Church in Northeast Baltimore, who already operates a traditional opioid treatment program “Turning Point”, said he would start offering “open access” methadone – treatment within 15 minutes – on July 5.

No, it’s not endorsed by the Maryland Alcohol and Drug Abuse Administration or the state’s health department, which has not given approval for the scheme. But Williams said his church is going to go forward with it anyway, adding that he would be able to treat 100-150 more patients a day.

And Williams has a well-placed and powerful supporter: the Baltimore Police Department. Even the police department is in favor of Williams’ plan.

The Baltimore Sun published stark statements from the police department saying that arresting addicts was not going to happen anymore. Detective Donny Moses, spokesman for the department, said he “had a change of heart” about arresting addicts after five years in the narcotics division. “I must have arrested a million and one people addicted to heroin, and I thought there had to be a better way,” he said. “I was thinking this was someone’s daughter or son and someone was praying for you.” Moses added: “The Police Department is no longer interested in locking up all the addicts.”

And Lt. Col. Ross Buzzuro from the police commissioner’s office said: “We can’t arrest ourselves out of this problem.”

Some critics rightly point out that counseling and other services are important, as well as methadone, to treatment. But in the absence of any funding for extra treatment, giving out the medication will at least give patients a safe option to street use of heroin or other drugs.

Like so many people who are passionate about treatment, Williams has personal reasons for being involved. His daughter was shot in a drug deal in 2002. She left three children behind.

On one side a pastor who is a zealous advocate, a community which is infested with drug deals, a police department that knows what drugs are doing to the neighborhood, and a drug that has been the single most successful treatment for opioid addiction for more than half a decade – and on the other bureaucrats who may not step far outside their well-appointed offices and who see no problem with waiting lists lasting a month, not to mention rulemakings lasting years – and it’s not hard to decide which side has the moral imperative in this showdown.

Which will win is another story.

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