Methadone Deaths Tied to For-Profit Clinics Prompt Bills

At least five state legislatures are considering bills to tighten oversight of methadone clinics after allegations that take-home doses of the drug are contributing to illegal street sales, misuse and deaths.

Measures in West Virginia, Minnesota, Indiana, Pennsylvania and Maine, if passed, could increase costs or limit revenue for the nation’s largest methadone chains -- both of them backed by private equity firms: CRC Health Corp. is owned by Boston-based Bain Capital Partners LLC; and Colonial Management Group LP is in the portfolio of Warwick Group Inc. of New Canaan, Connecticut.

Police, prosecutors and state regulators have linked clinics operated by CRC and Colonial to doses of the synthetic narcotic that were diverted into black-market sales -- sometimes with deadly results.

The array of legislation reflects concerns that some for-profit clinics -- which distribute the synthetic narcotic to help patients beat addictions to heroin and other opiates -- don’t provide enough services, said Robert Lubran, director of pharmacologic therapies at the U.S. Substance Abuse and Mental Health Services Administration.

“We know for-profit providers often provide a lower level of service” than non-profit counterparts, Lubran said.

“It’s a question across the nation: Is it a cash cow these providers are running or are they really trying to help our citizens?” said Meshea Poore, a Democratic member of West Virginia’s House of Delegates.

Threatening Treatment

Many of the legislative proposals are misguided and pose a threat to methadone treatment, which is already rigidly regulated and has been used effectively to treat drug addiction for decades, said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, a methadone advocacy group.

“The system is in need of reform, but good reform,” said Joycelyn Sue Woods, executive director of the National Alliance for Medication Assisted Recovery, a patient advocacy organization. “Once you start passing all these laws, you make it impossible for people who need treatment to get treatment.”

In West Virginia, measures that unanimously passed the House of Delegates health committee last week would require at least one counselor for every 40 patients -- a ratio that’s lower than those in such states as North Carolina and Indiana. Clinics would also have to report to a legislative oversight panel on the number of take-home doses they distribute -- methadone that patients carry out instead of taking under staff supervision.

Crossing Borders

West Virginia clinics distribute take-home doses more often than those in neighboring Kentucky and Ohio, contributing to a high number of out-of-state patients, said Poore. “They come here, get their take homes and some sell them,” she said.

Poore offered an amendment to the West Virginia bill that would bar out-of-state residents from seeking treatment in West Virginia. It has been referred to the House of Delegates’ judiciary committee after passing the health committee.

Cupertino, California-based CRC, which operates seven of West Virginia’s nine methadone clinics, will oppose “any regulations that would restrict an individual’s access to quality, evidence-based treatment options,” said spokeswoman Kristen Hayes. She didn’t comment on specific bills.

Bloomberg News reported in February that investigators in West Virginia, Indiana, Kentucky and Virginia had linked diverted methadone that turned up in illegal street sales or deaths to carryout doses from CRC clinics. Former employees said their caseloads were sometimes so high they didn’t have time to provide adequate counseling or check on patients.

Meeting Rules

Philip Herschman, CRC’s chief clinical officer, called the article “misleading and biased” and said CRC meets rigid rules in deciding which patients get take-home doses.

In 2010, 4,577 people died of overdoses involving methadone -- down from 5,518 in 2007 yet almost six times the number in 1999, according to the federal Centers for Disease Control and Prevention. Much of the current state legislation is based on incorrect claims that attribute the increase to addiction treatment centers, Parrino said. Instead, most methadone overdose deaths stem from physicians’ prescribing the drug as a pain killer, he said, citing national studies.

In Minnesota, legislation to tighten methadone clinic rules followed a state decision to revoke the license of Duluth’s Lake Superior Treatment Center. Inspectors found patient caseloads were too heavy and take-home doses weren’t properly controlled. Methadone from the clinic has leaked into illegal street sales, said Dan Danielson, an investigator with the Carlton County Sheriff’s Office.

Nine Deaths

Nine people connected to the 4,000-member Fond-du-Lac Band of the Lake Superior Chippewa tribe died last year in incidents involving methadone, said Phil Norrgard, the tribe’s human services director. In one of those cases, authorities have traced the methadone to the Duluth clinic, Norrgard and Danielson said.

Colonial Management, which operates that clinic and more than 50 other treatment centers in 18 states, has appealed the revocation. Christopher Hassan, the Orlando, Florida-based company’s chief executive, declined to comment, according to his assistant, Renee Seabridge.

“We thought Minnesota was the worst,” said Thomas Huntley, a Democratic-Farm-Labor party member and state representative from Duluth who co-sponsored the methadone bill in the Minnesota House. “This has become a very national issue.”

Provision Struck

In Indiana, a bill would require a legislative commission to study the use and prescribing of methadone and how to improve monitoring of patients.

A House committee on Monday struck from the measure language that would have required clinics to run patients’ names through a state prescription database to check for other sources of methadone or pain-control medications. That provision would have helped prevent methadone’s misuse, said its sponsor, Patricia Miller, a Republican state senator from Indianapolis.

The requirement ran afoul of federal patient-privacy laws, said Lubran, the U.S. substance-abuse official. Lawmakers also stripped out language that would have limited methadone treatment in Indiana clinics to two years.

Miller’s bill was revised after her committee heard testimony from five opponents -- two who represented CRC, two from a non-profit mental health agency and a professor of addiction psychiatry at Indiana University’s school of medicine.

CRC served 69 percent of Indiana’s 14,200 methadone patients in 2011, according to state records. That year, the company’s East Indiana Treatment Center in Lawrenceburg saw 2,479 patients -- just 380 of them from Indiana, records show.

Study Required

To counteract state proposals aimed at restricting methadone treatment, the American Society of Addiction Medicine has begun an advocacy campaign, said president Stuart Gitlow. “You wouldn’t say to a person with a chronic condition like diabetes, you’ve been doing well on your insulin for two years and now it’s time to stop,” Gitlow said.

In Maine, a measure that took effect in January caps state funding for methadone patients at 24 months. Now Lawrence E. Lockman, a Republican representative from Amherst, has sponsored a bill to ban the state Medicaid program from paying for any methadone treatment.

“Some of these clinics are doing little more than dispensing the drug,” Lockman said. “There’s very little accountability. The for-profits in particular don’t have a lot of incentive to taper people off of the methadone they’re getting paid for. We need some accountability so taxpayers know what we’re getting.”

For-Profit Clinics

Bethany Allen, an aide to Maine House Republicans, cited clinics in Bangor operated by Colonial Management and Discovery House, a Rhode Island-based, for-profit chain that operates 18 clinics in four states.

There’s no difference between standards at for-profit and nonprofit methadone clinics, said Richard Froncillo, an ombudsman for Discovery House. All have to follow the same rules set by at least four state and national organizations, he said.

Discovery House also opposes legislation under consideration in Pennsylvania that would make it harder for patients to get take-home doses during their first six months of treatment, Froncillo said. The company follows state and federal rules in distributing take-home doses, he said, and its clinics require patients to account for their carryout bottles.

Pennsylvania lawmakers last year created a “methadone death and incident review team” that’s charged with examining the circumstances of methadone-related deaths in the state, including car crashes and overdoses.

“We need to get a handle on how the deaths happen and where the methadone is coming from,” said Gene DiGirolamo, a Republican from Bensalem who helped craft the bill.

Before it's here, it's on the Bloomberg Terminal.