VIRGINIA REVOKES CLINIC'S LICENSE

A Charlottesville Methadone Clinic, Connected to a Fatal Overdose, Will
Operate Under New Ownership.

A methadone clinic in Charlottesville allowed
high-risk patients to take home large amounts of the drug, which
caused at least one fatal overdose, according to a state inspection
that uncovered enough problems to warrant revoking the clinic's license.

But rather than shut down a facility that violated more than 160 state
regulations, the Department of Mental Health, Mental Retardation and
Substance Abuse Services decided last month to allow the Pantops
Clinic to remain open under new ownership.

"Many of these are repeat citations and are very serious," department
Commissioner James Reinhard wrote in a March 2 letter informing clinic
operator Dorothy Tompkins that her license was being revoked.

It was the first license revocation of a methadone clinic in Virginia
that Ralph Stroufe, regional manager of the department's office of
licensing, could recall. There are about a dozen methadone clinics in
the state.

State regulators decided to allow the Pantops Clinic to remain open on
the condition that it be sold to Addiction Recovery Systems of
Pennsylvania, which now has 90 days to obtain a state license.

"It's obvious that the state of Virginia was not pleased with the way
the clinic was operating," said Jeff Kegley, president of Addiction
Recovery Systems. "There will be a number of changes going forward,
and the clinic will operate according to the state and federal
regulations."

According to documents released Monday, one woman who died from a
methadone overdose had an empty prescription bottle from the Pantops
Clinic in her purse, and another person who suffered three nonfatal
overdoses told state police that she purchased the drug from a clinic
patient. Neither woman was a patient at the clinic.

Such abuse is one of the fears raised by opponents of a proposed
methadone clinic in Roanoke.

"We have a list of concerns, and that's certainly at the top of the
list," said Jeff Artis, who is leading community opposition to a
clinic expected to open within the next few months on Hershberger Road.

However, state inspections have found few problems at the other two
methadone clinics in Western Virginia. Those facilities, in Galax and
Tazewell County, are owned by the company behind the Roanoke proposal.

Gail Burruss of Blue Ridge Behavioral Healthcare, the largest
substance abuse treatment provider in the Roanoke Valley, cautioned
against making too much out of the failings of a single facility.

"This sounds like gross medical negligence that seems to be an
aberration," Burruss said. "But at the same time, I think it does call
attention to the need for the stakeholders in the medical, treatment
and criminal justice agencies to be attentive to the practices and
procedures happening at any methadone clinic."

The outpatient centers, which dispense daily doses of methadone as a
form of treatment for addicts of opium-based drugs such as heroin and
OxyContin, are proliferating in Western Virginia in response to a
growing prescription drug abuse problem.

Names of the two overdose victims were deleted from records of the
state's investigation of the Pantops Clinic. The documents were
released Monday to The Roanoke Times under the Virginia Freedom of
Information Act.

In the case of the fatal overdose, a patient at the clinic said a
friend apparently came to her home and took methadone from a lockbox
provided for take-home doses. An empty prescription bottle for 125
milligrams of liquid methadone was later found in the victim's purse,
according to inspection records.

In the second overdose case, regulators have forwarded to state police
the surviving methadone user's allegation that she purchased the drug
from a Pantops patient.

Such diversion of methadone is especially troubling given the clinic's
lack of oversight in providing take-home medication, Reinhard wrote in
his letter to Tompkins.

Generally, new patients are required to report to the clinic every day
to receive doses of methadone. Those who respond well to the treatment
over time are allowed to take home up to a week's supply of the drug.

But some patients who transferred to Pantops from other clinics were
given up to a month's supply of the narcotic upon admission, even when
their take-home privileges had been reduced at their previous clinics
due to positive drug tests and other problems. One patient was given
27 doses of methadone his first day at the clinic, even though he had
not seen a counselor.

At a meeting last week of the Roanoke Valley Drug and Alcohol Abuse
Council, Burruss reviewed the proposed take-home policy for the
Roanoke Treatment Center, the clinic proposed for 3208 Hershberger
Road. Although patients must report to the clinic six days a week for
dosing in their first three months of treatment, the plan calls for
gradual cutbacks in attendance requirements to the point that patients
in the program for two years or longer can receive up to 31 take-home
doses.

"It seems like a fairly generous schedule," Burruss said. But that's
not necessarily a problem, she said, as long as the clinic is
providing enough counseling and other forms of treatment in
conjunction with other programs in the region.

Security was also a problem at the Pantops Clinic, which is located in
a predominantly commercial area just east of Charlottesville.

"The pharmacy door and medication safe door are open and easily
accessible to patients and staff," one report noted.

Other problems included: A clinic nurse at times dispensed methadone
without the approval of a doctor or pharmacist; record keeping was
often insufficient; patients were not seeing counselors as required;
employees were not properly screened; and treatment plans for many
patients were not updated.

Tompkins, a private physician who opened the clinic two years ago as a
nonprofit venture, is no longer affiliated with the operation.

She said Monday there is no proof that the clinic was responsible for
the overdoses.

"No patient was harmed," Tompkins said. "There's no proof that anyone
was harmed, and a lot of people were greatly helped."