Opioid addicts need another clinic in Modesto. Why are officials not supporting it?

Randee Miller of Modesto talks with counselor Frances R. at the Aegis clinic in Modesto, Calif., on Friday, Oct. 6, 2017.
Randee Miller of Modesto talks with counselor Frances R. at the Aegis clinic in Modesto, Calif., on Friday, Oct. 6, 2017.

Randee Miller of Modesto said she regularly took prescription painkillers after several surgeries, including one operation to reconstruct an injured foot.

When her doctor made the decision to stop her prescriptions, Miller said, she suffered terrible symptoms of withdrawal. She found that smoking heroin relieved the abdominal cramps and nausea.

“Someone said, ‘Smoke this, you will feel better’,” Miller said. “I did, and bang, I was addicted to heroin.”

Miller is one of 850 patients of the Aegis Treatment Center on McHenry Avenue and one of the millions of people caught up in the nation’s opioid addiction crisis. According to state agencies, more prescriptions for narcotic painkillers, such as hydrocodone and Fentanyl, are issued in Stanislaus County than the county’s adult population.

With the opioid epidemic, many residents become dependent on painkillers and then switch to lower-cost heroin when their prescriptions are cut off or they can’t afford to buy the pain bills on the street.

The Aegis clinic is on the front line of battling the epidemic by administering methadone to patients that quiets the cravings for drugs. The clinic also provides counseling to help them with recovery.

Aegis wants to open a second clinic in Modesto that would make its services more accessible for folks who need help and would reduce the traffic at the McHenry center, which has spawned complaints from neighbors. About 500 clients is a more appropriate patient load for such a clinic, Aegis says.

Aegis Treatment Centers, the clinic’s parent company, says its needs support from Stanislaus County, which would be expected to commit 5 percent of the funding for a second clinic. But the county has not supported the proposal. In four years, county departments such as the Health Services Agency and Behavioral Health and Recovery Services have not brought a proposal to the Board of Supervisors.

“We have been speaking to the county health people for four years,” said Alex Dodd, chief executive officer of Aegis, based in Canoga Park. The CEO said he’s also talked to county supervisors and other officials.

Dodd said responses from county staff have varied: We’re too busy; there’s no money; or county supervisors won’t like the idea.

“They have said they have to take it to the Board of Supervisors, but nothing has happened,” Dodd said.

The funding for a second clinic would primarily come from federal and state programs such as Medi-Cal. The 5 percent from the county would amount to a few hundred thousand dollars a year, Dodd said. The city of Modesto also would be involved in approving any site for a second clinic within the city boundary.

In the meantime, people with addictions wait for weeks or months to get treatment at the McHenry clinic, which has recently had 300 names on a waiting list.

A few years ago, an Aegis clinic manager started calling people on the Modesto waiting list. On the first three calls, family members said the person had died.

Rather than wait, some county residents have gone to clinics in Stockton or Merced for a daily dose of methadone. Such a daily trip is not practical for clients, who have to pass urine tests and jump through other hoops before they’re given a week’s supply of methadone to take home.

With only a few other sources of methadone in the county, some people on the waiting list return to dealers on the street. “They are going back on something that helps with the stomach cramps, the chills and the sweating,” said Ruthanne Hernandez, a client and patient advocate at the McHenry clinic.

At one point, more than 500 addicts were on the Aegis center’s waiting list.

What county officials say

Stanislaus County leaders acknowledged last week they have talked with Aegis representatives, and they agreed the treatment center provides a valuable service. But no one contacted by The Bee was clear on why the Aegis proposal has not moved forward.

“There is definitely a need,” Supervisor Terry Withrow said. “There is obviously an epidemic in this country not just in Stanislaus County.”

Withrow noted that “everyday people” are caught up in the opioid crisis, not just the typical addicts on the street.

Board Chairman Vito Chiesa recalled a conversation with Aegis representatives about six months ago. He said Aegis wanted to open a second location. Chiesa said he was told about neighbors’ complaints about the number of people treated at the McHenry site and that Aegis wanted to reduce the client population there.

“I thought it was a reasonable proposal,” Chiesa said. “There is no doubt addiction is a big problem. Beyond that conversation, I have not heard from them since.”

Supervisor Jim DeMartini said he was not aware of Aegis’ request for a second clinic.

“I don’t have a problem with it,” DeMartini said. The county could afford to kick in support for a second clinic, he said, but the location could stir emotions if it’s near a residential neighborhood.

“I think it’s our obligation to the public to wean these people off the drugs,” DeMartini said. “We should have the capacity to take care of the people in this county without sending them out of the county for treatment.”

DeMartini said the cost savings for society is far greater than the cost of the recovery services.

According to the U.S. Department of Health and Human Services, a county spending $1,600 on substance abuse treatment in California saves $11,500 in costs in terms of lower medical and hospitalization expenses, less spending on psychiatric hospital care and reduced costs for the criminal justice system.

Dodd said he’s talked with management at Doctors Medical Center about the potential for reducing drug-overdose emergency room visits by opening another clinic.

Local overdose deaths

The stats on drug overdose deaths handled by the Stanislaus County coroner’s office appear significant. In 2015, the coroner tallied 167 deaths in which an overdose or drug abuse was the primary cause. Almost every other day that year, emergency crews or the coroner’s office responded to those drug-related fatalities.

Of those cases, 50 deaths were caused by opiates or opioid prescription drugs, 26 deaths were caused by heroin and 46 by other prescription drugs. Other causes of death were methamphetamine (34), cocaine (9), the synthetic cannabinoid K-2 (1) and other drugs (1).

Last year was not as bad, but the coroner’s office still recorded 37 deaths due to opiates or opioid prescription drugs, while 19 deaths were attributed to other prescription drugs and 11 died from heroin use. Fifteen deaths were attributed to methamphetamine and cocaine.

Coroner’s statistics won’t include all deaths from overdoses and drug abuse, because of the different ways overdoses are coded on hospital medical records or recorded on death certificates, said Dr. Lyn Raible, medical director for the 30-plus Aegis clinics in California.

The clientele at the Modesto clinic are not just addicts on the streets, she said. In her three years with Aegis, the facility has taken care of people in law enforcement, nurses, other professional folks and college students, Raible said.

“When folks get treatment, they get back to their lives. They have normal lives,” the physician said.

Raible said that bus service is not adequate enough to make the McHenry clinic, or even a second location, very accessible for residents of Turlock or Oakdale. Therefore, a second clinic alone won’t be an answer for everyone.

The Aegis clinic spawned numerous complaints when it was situated near Modesto Avenue and McHenry several years ago. Clients’ cars blocked driveways in the adjacent residential area. Trash was dumped in gutters. Cars raced down the narrow streets.

Modesto Councilwoman Kristi Ah You said Aegis has been a better steward at the newer site near McHenry and West Roseburg Avenue. Private security or other staff talk to patients who loiter in the neighborhood or cause commotion in the parking lot. But in Ah You’s opinion there are still problems.

Ah You said police calls for service have increased around Aegis and the nearby Walgreens since the clinic was moved to that area. “I also have spoken with homeless people who say they live in the area to have access to methadone each day,” the councilwoman said.

“I understand the value of the program, but you have to consider how it affects businesses and neighbors with that sort of traffic,” she added.

Possible locations

Dodd said that Aegis has considered a second site near 12th and F streets in the downtown. Another possibility is a location west of Highway 99 in the Paradise Road area. Withrow said he is open to exploring a west Modesto location.

As of Friday, no county official had committed to pushing a proposal forward. The Health Services Agency referred a Bee inquiry to county Behavioral Health and Recovery Services, which did not return a call.

Raible said that Aegis will continue seeking county support for a second clinic, even though going public with its concerns may ruffle feathers. Aegis has more than 60 staff members at its current clinic, where three managers share an office and clients are served seven days a week.

Julio Pacheco went to the clinic Friday in his determined effort to break what he said is a heroin addiction. The Modesto resident said he wants to be a role model for his 9-month-old son, Xavier, who was in a stroller, and a 9-year-old son. Pacheco hopes to enter a training program for welders after kicking the habit.

When he first started on the road of recovery, he said, it was hard making daily trips to the clinic for the pink-colored methadone doses. He has since earned the privilege of take-home doses. A second clinic would help many residents in other sections of Modesto, he said.

“There are a lot of people trying to get off drugs and they don’t make it,” Pacheco said.

Ken Carlson: 209-578-2321, @KenCarlson16