Methadone clinics need more stringent regulation

Published on November 13th, 2014 By SentinelSource.com The nation’s growing addiction to opiates is affecting millions of Americans. Among them are an estimated 1 million heroin users and more than 300,000 people taking methadone to help control their addiction. Those methadone patients are the backbone of a huge industry, one that, it turns out, has a spotty record of oversight. In a four-part series that can be found at www.sentinelsource.com, The Sentinel’s Ella Nilsen examined how methadone is being used to help local addicts, how local clinics are run, and the effects on the community when treatment goes awry. Her investigation began with the results: In April 2008, a jogger on Keene’s North Lincoln Street was struck by a car and thrown over a fence. After months of surgeries and rehab, Jenna Lydon still walks with a limp and bears the scars of that crash. The driver who hit her had fallen asleep at the wheel after taking a dose of methadone obtained at the Keene Metro Treatment Center in Swanzey, where he was a patient. He said becoming drowsy while driving after his daily methadone treatment was not uncommon, and that his dosage of the drug was often raised solely at his request. Starting with that incident, Nilsen subsequently found other former patients and staff at the facility who allege the center doles out higher-than-recommended doses of the drug. Lawyers for Lydon said the facility’s former medical director — the person responsible for all medical decisions made there — testified that he basically had no knowledge of the company’s policies or procedures, that he was never trained and that he was unaware the state even had regulations regarding methadone clinics. In fact New Hampshire, like many states, has few laws pertaining to methadone treatment, despite the fact that the drug is a dangerous Schedule II narcotic, the same status awarded methamphetamines, fentanyl and morphine. New Hampshire RSA 318:B focuses on the licensing requirements involved in setting up such clinics, the paperwork needed to retain those licenses and the fees they will pay each year to be licensed. It does have extensive regulations for methadone clinics, but the Bureau of Drug and Alcohol Services leaves the actual oversight to “national accreditation bodies” approved by the federal Department of Health and Human Services. The problem with that, as the state of Minnesota found, is such organizations may not be reliable. A probe by that state’s Human Services department found dozens of violations at a clinic owned by Colonial Management Group, which also owns the Swanzey clinic. The national accrediting agency CARF — the nonprofit Commission on Accreditation of Rehabilitation Facilities — had given the same Minnesota clinic a glowing report only months before state investigators recommended it be shut down. New Hampshire relies on the same organization for its “oversight.” Partly, the Granite State’s issue is money. The New Hampshire Advantage apparently doesn’t include funding for the Bureau of Drug and Alcohol Services to inspect methadone clinics or verify they’re adhering to state and federal drug laws. But even if the funding was there, the bureau’s director said it would be redundant to do such inspections, since they’re already presumably being done by CARF. Such clinics are cash cows, run by huge conglomerates that have little incentive to wean patients from the drug. Certainly the staff at the local level may be interested in the well-being of patients, but the bottom line for the larger company relies, in part, upon the addiction being transferred from heroin to methadone — then remaining in place, often for years, despite state regulations calling for treatment plans that will taper patients from the drug. With those in regulatory positions focusing on paperwork and licensing rather than inspecting and reporting, the danger is twofold: The first is the danger to the public from drivers who are either high or drowsy, as was the case in the Keene crash that injured Jenna Lydon. The second is that methadone itself poses a risk of fatal overdose, alone or in combination with other drugs. Methadone certainly has great potential for helping the state in its battle with the growing epidemic of opioid abuse. But only if those taking it are appropriately referred to rehab programs that are strictly monitored. New Hampshire needs to stop relying on others to do the job of protecting its citizens — on the roads or in their homes.