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Sunday, January 04, 2004

Methadone a booming business in Western Virginia

Opponents say it's all about money, but one methadone clinic operator says it's not a way to get rich quick.

By Laurence Hammack

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    Four years ago, there were no methadone clinics in Virginia west of Richmond.

    Now there are three. Soon there may be six.

    The proliferation of the treatment programs, which dispense methadone daily to help addicts break their dependence on other drugs, is attributed to the region's long-standing problem with prescription drug abuse that peaked around 2000 with the emergence of OxyContin.

    "OxyContin is a medication that is so strong it bottomed out a lot of addicts" and forced them into treatment, said Tina Bullins, chief executive officer of the Life Center of Galax, one of three companies that have considered opening clinics in the Roanoke Valley.

    But a truly altruistic concern for treating drug addicts is not the main reason methadone clinics are popping up like mushrooms across Western Virginia, opponents say.

    Methadone, they say, is all about money.

    "It's a cash cow," said Michael Bragg, an attorney who represents residents opposed to a proposed clinic in Washington County. "You get someone hooked on methadone, and you don't want to cure them, you want to keep them on the methadone and keep the money coming in."

    Methadone clinics typically meet resistance from nearby residents who fear that an influx of addicts will bring crime and drug dealing to their neighborhoods. But opponents also say the treatment - which costs about $10 a day and can last for years - often becomes a business run by corporations more concerned about the bottom line than with addicts who have bottomed out.

    While methadone providers dispute that, they clearly are part of a growing business.

    Since March 2000, when the region's first clinic began treating addicts in Galax, two other clinics have opened, in Tazewell County and Charlottesville. Two companies have announced plans for clinics in the Roanoke Valley. A third firm filed an application for a state license and quietly surveyed the methadone market before putting its plans on hold. Yet another clinic is proposed in Washington County.

    What is happening in Western Virginia has been playing out on a national scale over the past decade.

    In 1993, there were 775 methadone clinics in 40 states that treated 115,000 people addicted to opium-based drugs such as heroin and OxyContin, according to Mark Parrino, president of the American Association for the Treatment of Opioid Dependence in New York.

    Today, more than 1,100 clinics in 44 states are treating 205,000 patients, Parrino said.

    Increased amounts of heroin being smuggled into the country and a growing problem with prescription drug abuse are feeding the demand for methadone clinics, according to Parrino.

    Those who fault private companies for profiting from the problem miss the point that the service is desperately needed, he said. "Is there any question when a doctor sets up an office" in a medically underserved area? Parrino said. "It's an access-to-care issue."

    As long as methadone clinics provide quality care and work well with other drug treatment programs in the area, James Sikkema believes, the issue of making money should be a nonissue.

    "People can make money and provide quality services and do the right thing; there's nothing wrong with that," said Sikkema, executive director of Blue Ridge Behavioral Healthcare, the valley's largest provider of substance abuse treatment.

    "It's just that they're facing challenges from the profit-margin point of view," he said. "The challenge is not to compromise quality and services out of concern for the dollar, which is hard."

    Last month, when the Life Center of Galax abruptly dropped plans for a methadone clinic in Roanoke County, it appeared to clear the way for a second proposed clinic to become the valley's first such operation since the 1970s.

    But the Roanoke Treatment Center, which National Specialty Clinics plans to open within a few months at 3208 Hershberger Road, may soon have competition.

    The Life Center has not given up on the region.

    "Our goal continues to be to locate and open a medical clinic as quickly as possible in order to treat the citizens of the valley and to do so while working with the community as a good neighbor and citizen," Bullins said.

    A third company filed an application in April with the state to operate a methadone clinic in Roanoke, but has since let the lease on its site expire and is no longer actively pursuing locations in the area.

    So at least for now, the controversy is limited to Northwest Roanoke, where community activist Jeff Artis says "economic racism" is behind plans for the clinic.

    According to Artis, National Specialty Clinics picked the black community as the path of least resistance to the profits of dealing in methadone.

    "They're just as money-hungry as the drug dealers are," he said of the Nashville, Tenn., company.

    National Specialty Clinics estimated that its Hershberger Road clinic will bring in revenues of $492,580 in its first year of operation, according to a license application the company filed with the state Department of Mental Health, Mental Retardation and Substance Abuse Services.

    After paying the relatively low cost of methadone, rent on the building, salaries and other expenses, the clinic is projected to reap a profit of $127,026. Taxes will reduce that annual sum to $80,027.

    That amounts to a profit margin of about 16 percent, which is substantially higher than the norm in the health care industry, said Jan Clement, a professor of health administration at Virginia Commonwealth University.

    National Specialty Clinics operates 16 clinics in six states. In the past four years, it has opened six clinics in West Virginia. The Hershberger Road site will be its first clinic in Virginia.

    The company's growth mirrors a national trend in which the independently run methadone clinics are being replaced by ones run by large corporations, according to Joycelyn Woods, president of the National Alliance of Methadone Advocates.

    Methadone clinics in large, urban areas are more likely to be nonprofit operations affiliated with a hospital, Woods said. In the more rural areas of the country, where OxyContin abuse is often widespread, the clinics are usually run by private, for-profit companies.

    Of 1,215 methadone programs surveyed three years ago, 54 percent were private, for-profit operations, according to Leah Young of the U.S. Substance Abuse and Mental Health Services Administration. Another 35 percent were private, nonprofit clinics, and the rest were run by local, state or federal governments.

    Woods said the level of treatment can be equally good - or equally bad - at nonprofit and for-profit clinics, depending on the staff and other variables. "I've seen government clinics that are real bad and private clinics that are beautifully run," she said.

    When Dr. Dorothy Tompkins decided to open a methadone clinic in the Charlottesville area last year, she didn't want it to be part of a large corporate structure.

    "Our goal is to treat patients, not make money," she said of the private, nonprofit Pantops Clinic.

    "Each patient has different needs," she said. "By keeping this operation relatively small, we don't have to answer to another whole different set of regulations imposed by a corporation."

    And by turning all profits back into the clinic, Tompkins is able to offer additional services to her patients, such as reduced fees based on financial need.

    Medicaid does not pay for methadone treatment in Virginia, and only a small number of clinic patients are covered by private insurance. Although $70 a week for treatment can add up, methadone providers point out that most of their patients spent far more on their illegal habits.

    By downing a dose of liquid methadone once a day, opioid addicts can escape their cravings for illegal drugs and avoid withdrawal symptoms. Methadone, a synthetic narcotic developed during World War II as an alternative to morphine, is also prescribed as a painkiller.

    Although patients do not get high when they use the drug properly, they do become dependent on it, leading critics to say methadone maintenance programs replace one addictive drug for another. It can take years for a methadone patient to gradually be taken off the drug; some addicts need it indefinitely.

    Methadone clinics are governed by extensive state and federal regulations. They are also required by law to be accredited by one of several agencies, and they must obtain permit from the Drug Enforcement Administration to prescribe methadone.

    All that regulation casts doubt on the theory that the clinics are only after an easy dollar, Parrino said.

    "It's not like opening a pizza shop," he said. "You can't just open the shop and sell to whoever you want to sell to."

    While Tompkins prefers the nonprofit arena, she too rejects the argument that methadone companies are in the business solely to make money fast.

    "They're not going to get rich quick off this," she said. "There's just no way. There are so many regulations as far as fulfilling the needs of the patients, they can't charge the patients enough to get rich quick."

    And even if they do turn a profit, Woods said, "That shouldn't even be an issue."

    "The issue is: Are you providing comprehensive treatment so the patients can get their lives together and become productive members of the community?"

    If the answer to that question is yes, methadone advocates say, the real profits go to the community.

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