County officials back proposal for second methadone clinic in Modesto

Stanislaus County officials are supporting a private company’s proposal for expanding access to methadone and similar treatments for people who want to break addictions to opioids.

Aegis Inc. is considering locations for a second methadone clinic in Modesto to relieve pressure on its McHenry Avenue office amid the opioid epidemic. The state also has awarded a “hub-and-spoke” grant for Aegis that could extend its services to Oakdale and Patterson.

Company representatives said they have had favorable discussions with county and city officials regarding the second clinic in Modesto.

“What we agree to do is assist them in any way we can,” said Rick DeGette, director of county Behavioral Health and Recovery Services. “We are working closely with them. We don’t want to miss an opportunity to provide access to care.”

With more than 30 clinics in California, Aegis administers methadone and other drugs to eliminate the cravings and withdrawal symptoms for people addicted to heroin or narcotic painkillers. Its clinics have sparked some controversy in other cities over methadone treatment and potential issues with neighbors.

The company has not decided where to put the second Modesto clinic. A $5 million state grant for Aegis could extend service to Oakdale and Patterson from a hub in Manteca, as part of a state response to the opioid crisis.

Physicians in Oakdale and Patterson could prescribe Suboxone for patients opting for medication-assisted treatment. The grant would pay for Suboxone, a safer but more expensive alternative to methadone, for addicts who lack insurance and would augment the outlying services with counseling and nursing support, Aegis Medical Director Lyn Raible said.

Aegis also has a goal for a medical unit in Turlock serving people addicted to opioids.

In a preliminary estimate earlier this year, the Centers of Disease Control and Prevention reported more than 42,000 overdose deaths in 2016 caused by opioid drugs such as heroin and pain pills, which was a 28 percent jump over 2015.

The new methadone clinic in Modesto will be smaller than the McHenry office, which serves 850 clients and has up to 300 names on a waiting list. Aegis promises a well-managed second clinic with around 500 patients.

“We don’t want them to feel like cattle getting herded through the office,” Raible said. “We want to operate as a medical office as much as possible.”

Methadone treatment was established in the 1970s for treating widespread heroin addiction and deterring drug-related crime, but has long been criticized for replacing one addictive drug with another and fostering long-term dependance in patients who stay on the drug for years. Methadone can be dangerous if mixed with alcohol and can be abused for euphoric and sedative effects, though it’s less intense than heroin.

A safer drug such as Suboxone has not supplanted methadone at the local Aegis clinic. Raible explained that the Medi-Cal program does not pay for Suboxone in narcotic treatment programs. It’s usually not covered by private insurance and is twice the cost of methadone for clients who pay out of pocket.

Patients can slowly taper off methadone but those managed by Aegis outpatient clinics are in no hurry to start the process.

“They should not be in a rush to taper down,” Raible said. “Our patients are with us an average of two years. We encourage them not to start tapering until they are stable for six months.”

Aegis cites research indicating that relapse is less likely among patients using methadone or Suboxone for longer periods. Drug addiction produces changes to neurons in the brain and with long-acting treatment with methadone, the neurons gradually return to normal function.

Aegis and Stanislaus County’s Genesis Narcotic Replacement Therapy program did not provide data on the number of patients who taper off methadone, a careful process that involves gradually reducing the daily dose.

Genesis, managed by county Behavioral Health and Recovery Services at 800 Scenic Drive, is another local source of methadone treatment, serving more than 370 people last year, including 312 new clients. Along with daily doses of methadone, the county program provides counseling and referrals to additional substance abuse treatment.

Genesis recently began issuing emergency prescriptions for Narcan, a medication that can stop the dangerous effects of opioid overdose for patients who relapse.

Dawn Vercelli, chief of county substance abuse services, said methadone patients have physiological dependance but don’t experience the impairment of opioid abuse if the drug is taken as prescribed. Regardless of the stigma of methadone treatment, studies over four decades have confirmed its benefits including fewer deaths among addicts, better compliance with mental health treatment, reduced crime and transmission of HIV, and recovered addicts returning to work and paying for housing, Vercelli said.

Clients may choose to taper off of methadone, but the cravings and withdrawal symptoms of opioid addiction may return, so the Genesis program makes staff support available, Vercelli said. People who relapse run the risk of a deadly overdose, she noted.

The director said the county program would need to generate a special report to provide data on how many clients are weaned off methadone.

Not a cure-all

Some families caught up in the crisis don’t think methadone is the cure-all for the opioid addiction. Modesto parents like Valerie Oehrke say methadone is not for everyone and more needs to be done to lower barriers for people who need to detox and gain access to recovery programs.

Oehrke said her 23-year-old son, who needed to withdraw from heroin, was turned away from the county’s Stanislaus Recovery Center in Ceres. A hospital emergency room was not able to provide assistance and private facilities wanted to charge thousands of dollars for detox service, she said.

Oehrke and her husband have twice nursed their son through detoxification at home, wrapping him in a blanket and giving him over-the-counter medicine for diarrhea.

According to Oehrke, an insurance carrier would not pay for inpatient treatment for her son after his release from an Oregon jail because he had not used drugs in the lockup. When her son relapsed and nearly died from an heroin overdose in a Seattle airport restroom, the insurance carrier approved treatment at New Hope Recovery in Modesto.

New Hope’s staff was able to negotiate more than 30 days of addiction treatment for the young adult, who is now in a sober living home.

“The problem is that clients don’t get the health care they deserve, they get what they negotiate for,” said Michelle Lucas, program director for New Hope, one of the privately run recovery programs in Modesto.

Lucas does not frown on methadone as one of the options for people trapped in addiction. New Hope is expanding its own reach with an application to serve as a vendor for the county’s Drug Medi-Cal delivery system, described as a new model for health services for residents with substance abuse disorders who are eligible for Medi-Cal.

New Hope also has plans for outpatient and residential treatment for 12- to 17-year-olds who are hooked on opioids. The services for adolescents could be offered starting in 2019.

This story was originally published December 29, 2017 at 5:40 PM with the headline "County officials back proposal for second methadone clinic in Modesto."