METHADONE PLAN MEETS WITH PRAISE, PROTEST

PRINCETON -- On one side of the Mercer-Raleigh county line, methadone
maintenance treatment was presented as a solution. On the other, area
businesspeople worried the addiction therapy would turn into a
scourge. Beckley Treatment Center and CRC Health Group officials
opened the Beaver facility's doors Friday in an effort to show the
public and people concerned about a proposed Mercer clinic how the
operations worked. CRC Health Group, a California-based company that
has worked in addiction treatment for the last 10 years, has filed an
application for a certificate of need to establish a similar clinic in
Mercer County. Vice President of Operations Joe Pritchard estimated
400 Mercer County MMT patients travel beyond county boundaries for
their daily doses of methadone in either Beaver or Tazewell, Va.

He said his company is petitioning the West Virginia Health Care
Authority for permission to build a clinic because there is a need for
methadone maintenance treatment in Mercer County.

"Four hundred patients driving a long way shows us there's a need,"
Pritchard said.

That's what CRC representatives will tell the HCA panel that will hear
both sides Tuesday in Charleston and ultimately decide whether the
clinic is headed here.

While MMT supporters presented their case in Beckley, executives at
the Princeton-Mercer County Chamber of Commerce were busy Friday
planning a caravan to protest the proposed clinic.

A group of citizens who oppose the certificate of need will pull out
of the PMCCC lot at 6:45 a.m. Tuesday on the way to Charleston to
speak out against the clinic they fear will only increase drug deaths,
draw crime to the area and harm future business opportunity.

PMCCC Board of Directors Chairman Roger Topping rallied for more
signatures on a petition against the clinic Friday during Business
Before Hours, just days after explaining to a Hope 4 Dope audience
that MMT clinics were one business the chamber would not support. "An
entity such as this will be very difficult for us, as an entity, to
sell to a business when they want to come into this community," he
said. Law enforcement officials have also been critical of any
proposed methadone clinic, citing an increase in methadone-related
deaths in the area during recent years and the growing popularity of
the often powerful, highly addictive drug on local streets.

It is particularly dangerous mixed with benzodiazepines, a group of
drugs prescribed to relieve anxiety and sometimes insomnia, but that
also depress the central nervous system, according to Medline Plus, a
resource of the National Library of Medicine.

How do clinics operate? Dr. Maria Encarnacion is medical director of
the Galax Life Center and an outpatient MMT center in Tazewell County.
She said anyone seeking MMT treatment in her centers must exhibit
physical and emotional signs of opioid addiction and a history of
dependence spanning more than one year. The only exception to the year
rule involves pregnant women. Those clients must be admitted,
according to federal law, no matter how long or short their history of
dependence, Encarnacion said. The Beckley Treatment Clinic medical
director, Dr. Ebineezer Obenza, was not on hand Friday.

After the initial medical evaluation, the MMT clients are assigned
counselors who meet with the patients to track their progress at least
once a week, Beckley Treatment Center Program Director Casey Aust
said. Often, clients need to meet with their mental health care
representative more than once weekly, but they must see the counselors
once each week in order to keep getting their methadone doses.

Once counselors meet with the clients, the MMT participants then claim
their doses at one of the dosing windows manned by licensed practical
nurses. Some MMT clients must take their methadone doses in the
presence of the nurses and speak to them afterward, ensuring they
swallowed the liquid that keeps them from going into withdrawal from
their drugs of choice. Others have been in the program long enough to
earn take-home privileges, meaning they don't have to report to the
clinic daily to get their doses. Their time in the therapy and their
behavior dictates how many take-homes patients are eligible for, Aust
said. All of CRC's treatment facilities are private, for-profit
entities, Pritchard said. In order to fund the programs, the
businesses charge on a per-dose basis for the substances that block
the opioid receptors in the brain, preventing withdrawal and
reportedly blocking the euphoria, or high, addicts experience from the
drugs they were originally hooked on. In Beckley, each dose costs
clients $12.50, while the average dose of methadone costs the clinic
approximately 30 cents to purchase. Aust and Pritchard were quick to
qualify that clients don't pay for the medication alone. They also pay
for unlimited sessions with their counselors, case workers and physicians.

"If patients put too much emphasis on medication, then they believe
it's the medication that's helping them," Aust said.

"Medication is only a small process," Pritchard said. "...only there
to stabilize the individual long enough, in a consistent manner, for
therapy to work." The clinic personnel argue that a person addicted to
opioid drugs cannot strive to improve their education, problem-solving
skills and relationships in the throes of withdrawal. Methadone keeps
their bodies fom going into withdrawal, thus freeing their minds to
work on other issues by saving detoxification for later.

The problem many opponents voice is that the patients are then no less
addicted to drugs than when they entered the program. They're simply
dependent on different substances.

For some MMT patients, that will never change. "There's a portion of
the opiate population that will always be on some kind of drug,"
Pritchard said. "The larger percentage of patients will not be." Aust
reported that most of her clients stay on methadone for 18-24 months
before slowly weaning themselves from the potent painkiller. Clinics
and communities According to a copy of the certificate of need
application, Treatment Associates Inc., a subsidiary of CRC, requested
approval to lease and renovate property in Mercer County totalling
approximately 2,000 square feet. If the CON were approved, Pritchard
said CRC officials would immediately seek a meeting with county zoning
officials to determine the best location for the proposed clinic.

The MMT clinic would have a capacity to serve an initial client
capacity of 370-390 people.

And, all of those people would pay $12.50 per day for their treatment,
a fact that raises the ire of opponents who see the clinics as private
businesses out to capitalize on others' addictions.

"They want to be in here for the money," Topping said last week.
Pritchard said the money had no place in the MMT debate. "If we're
providing good services and we're capable of providing good service,
that shouldn't even be an issue," he said Friday. He said fears of
crime and increased drug trade are common wherever clinics seek to
open.

"All concerns and all the fears are exactly the same," he said, adding
that he had never seen those fears realized.

In an earlier interview with the Princeton Times, Pritchard was
skeptical of reports that the Southern Regional Drug and Violent Crime
Task Force had traced drugs obtained in controlled buys back to
methadone clinics.

Since clinics administer liquid methadone while doctors who prescribe
the drug for pain dispense tablets or wafers, identifying whether the
drugs came from a private physician or a clinic should be fairly
straightforward.

When the methadone clinic debate began in late summer, task force Sgt.
J. Centeno reported his officers or cooperating individuals had
obtained methadone, some from clinics, in more than 20 controlled buys
within a few months. Although the numbers were not available, he later
said the methadone buys had climbed in later weeks.

CRC Wheeling Treatment Clinic Director Chris Byers said he makes every
effort to communicate with law enforcement officials whenever
possible. He also said he is quick to revoke take-home privileges or
even expel a client from treatment if he finds out the client is
either abusing the drug or diverting it to the streets.

He cited one example involving an undercover operation. He said he
told the officers, "The minute you have your case, you come tell me.
This guy's done." While Byers said he welcomed involvement from and
communication with law enforcement officers, he said federal laws
prohibit clinic officials from notifying investigators that methadone
may be diverted. To do so would be a violation of the federal law that
guarantees doctor-patient confidentiality, CRC officials said.

That same law also prohibits clinic officials from listing methadone
as a prescription in clients' files. If it were listed, in West
Virginia at least, that client's other doctors and pharmacists would
be able to access the patient's medication file on a Board of Pharmacy
website and know that the client was on methadone. To list the
addiction therapy there would also be a breach of confidentiality,
clinic officials said. To combat diversion internally, Byers said
clients with take-home privileges are called back at least once each
quarter for bottle checks -- an inspection of their methadone
containers to ensure they are dosing consistently and accurately.

And, he said clinics strive to educate their patients about the
possibly fatal mixture of methadone and benzodiazepines. In spite of
the overdose concerns, Byers said people involved in addiction
treatment have a 30 percent higher chance of survival that those
addicted but not in treatment. Opposition to the proposed clinic was
spurred to action after county leaders nearly missed the HCA hearing
on the certificate of need. The application and hearing were announced
in Charleston publications, but not in a publication in the local community.

Health Care Authority officials said Friday that was not due to action
from CRC. HCA regulations require that the legal announcements be
published in Charleston, according to state officials. What happens
now?

Pritchard said CRC, which administers MMT doses to an estimated 24,000
opiate addicts a day in 17 states, strives to keep a "local face to
what we do." In Raleigh County, and in Mercer if approved, that face
would belong to Aust, a Mercer County resident, who said she would
never think twice about having an MMT clinic in her back yard.

"I live in Mercer County. Those are my people. It's my county. I take
full ownership over it," Aust said, later emotionally adding that the
region's citizens have an obligation to try to stem the addiction
problem. "I see too many people every day who are dying. Socially, we
have a responsibility to do something," she said.

Back in Mercer County, however, the people who oppose the clinic
feared such a facility would only add to the problem.

"It's a legal way of getting drugs," PMCCC President Robert Farley
told the Princeton Community Hospital Board of Directors recently.
Another director at the meeting said she believed some clinics kept
people addicted for a lifetime.

According to a press release distributed by PMCCC, "The
Princeton-Mercer County Chamber of Commerce will lead caravan of
people to a hearing in Charleston on Tuesday, Nov. 28 in opposition to
allowing methadone clinics in Mercer County. The caravan will gather
at the Chamber office located at 1522 North Walker St. in Princeton
and will depart for Charleston at 6:45 a.m. The group is comprised of
Mercer Countians opposing the issuance of a Certificate of Need by the
WV Health Care Authority for the development of a methadone
maintenance treatment program in Mercer County as requested in CON
File No. 03-17771-BH." The West Virginia Health Care Authority is
located in Charleston off I-64, Greenbrier Street Exit (Exit 99). From
I-64 West, turn right on Greenbrier Street (Route 114) toward Yeager
Airport. Turn right at the top of the hill and enter Hillcrest Office
Park. Bearing left, at the second road on the left, turn left onto Dee
Drive. The Health Care Authority is located in the beige metal
building on the right, with double glass doors with black awning. Free
parking is located in front of the entrance, HCA authorities reported.