Judging from reactions in Ellsworth and Surry, methadone may be as unwelcome Downeast as heroin.
This spring, Ellsworth city councilors approved a six-month moratorium on any new clinic offering methadone treatment, with an option to extend the moratorium an additional six months. Shortly thereafter, Surry residents voted to enact a similar measure. And recently, Cherryfield residents voted overwhelmingly to change their land use ordinances to limit where methadone clinics could be located.
Methadone is known primarily as a drug used to ease withdrawal symptoms and drug cravings for recovering heroin addicts, but it’s also used for those battling prescription drug addictions. In recent years, methadone clinics sprang up in Bangor and Calais to meet growing addiction therapy needs in the region.
Advocates of methadone treatment say it’s sometimes the only option to stabilize patients suffering from acute withdrawal symptoms. But methadone and the methadone clinic industry increasingly have come under fire from some addiction councilors, who believe the methadone cure is worse than the disease.
Barbara Royal, executive director of the Open Door clinic in Ellsworth, dislikes methadone because it can be just as addictive as other opiates.
“[Clients] tell us it’s the most difficult drug they’ve ever withdrawn from,” Royal said.
Royal refuses admission into her program for methadone users who are not actively weaning off the substance. Instead of methadone, Open Door councilors recommend a short-term dose of the milder drug, Soboxone. With opiates like heroin and methadone, the higher the dose, the greater the “high,” but Soboxone blocks the brain’s ability to chemically experience “highs.” It also has a low-dose ceiling, limiting its effectiveness if taken in a higher dose than prescribed. Therefore, Royal said, there’s no incentive to abuse it.
Open Door’s addiction counseling program follows an abstinence-based model, and even Soboxone is only used for a short time.
“Recovery from our point of view is about internal change,” Royal said.
Participants must be sober, regularly attend Narcotics Anonymous meetings, and complete a 12-step program.
But some feel abstinence-based programs shouldn’t be the only available option. Judy Garvey and husband Jim Bergin head up Volunteers for Hancock County Jail Residents, a volunteer group providing services for the incarcerated.
Bergin is quick to point out methadone’s flaws and he feels the Bangor methadone clinic dispenses methadone with too little scrutiny. He said it’s too easy for clients to abuse the system and get more methadone than prescribed, take methadone in a way different than prescribed, or trade methadone for other drugs. This gets many recovering addicts nowhere, he said.
“It keeps the addict in the drug culture,” Bergin said.
He believes there isn’t enough counseling at the Bangor clinic, either. Counseling is critical because drug addicts often use drugs in an attempt to self-medicate undiagnosed or untreated mental illness, he said.
Bergin isn’t sure about the wisdom of centralized methadone clinics. He hoped in the future the drug might be administered in a less-centralized manner, like in private medical practices.
“You might get more personalized care,” he said.
But neither Bergin nor Garvey were willing to write off methadone completely. They both thought it was useful to stabilize some people undergoing acute withdrawal and to help keep some recovering addicts from returning to the drug. They point out that the success rate of quitting heroin “cold-turkey” is abysmally low; some studies suggest as low as 10 percent.
“Very few addicts can make it through clean,” Garvey said.
Garvey subscribed to a reduced-harm model of addiction treatment that’s more popular in Europe than the U.S.: methadone recipients may still be taking drugs, but the drugs are legal and easier to control.
“It’s better than dying or being in jail,” Garvey said.
Methadone detractors and advocates alike typically focus on the methadone clinic in Bangor, but another case study is available up the coast in Calais.
State Rep. Anne Perry (D-District 31) helped bring the Discovery House methadone clinic to Calais, and she now works there as a nurse-practitioner.
She said at first she and other community members were skeptical of methadone treatment as an option for treating the rampant drug abuse in the community, but they uncovered studies showing the drug’s effectiveness. One study Perry cited showed 60 percent of patients stabilized on methadone treatment for just two years were drug-free five years later.
“On the average, methadone is not a life sentence,” Perry said.
She said methadone is necessary for clients recovering from acute drug addictions who can’t be reached with Soboxone. Soboxone won’t work in those cases, she said, because the amount of drugs needed to help begin the weaning process is higher than what Soboxone can release.
“We never got them out of withdrawal,” she said.
Perry said she and others grew concerned that methadone recipients often used to spend their entire day driving between Bangor or Portland to Calais for treatment, leaving little time for any counseling.
“You’re spending too much time driving,” Perry said. “That’s not treatment,” Perry said.
Since Discovery House opened, Perry said she’s seen a positive change in the community, including a reduced crime rate.
“We have addicts who still behave like addicts, we [also] have a high number of people who are back at work, who have gotten their children back,” she said.
And Calais interim city manager Jim Porter said the city has improved since the clinic opened. Complaints about the clinic, more often than not, are minor, Porter said. He believes it helps that the clinic is located near the city’s large police force.
“Overall, it’s a success,” Porter said. “There are a lot of people getting treatment that were basically hopeless.”
It remains to be seen whether that success can be duplicated in places like Ellsworth or Surry, or whether it even will be given the chance to succeed.