Critics blast decision to close Stanislaus County’s narcotic treatment program
Stanislaus County is closing the Genesis Narcotic Treatment Program in the middle of an opioid crisis and amid growing concern over the need for drug addiction services.
The county Board of Supervisors last Tuesday characterized the action to close Genesis as a “management” decision. But people who are involved with addressing the opioid epidemic in the area said the decision came from out of the blue and should have been discussed with interested parties.
The decision was revealed last week as part of a project to demolish a building at the former county hospital site on Scenic Drive and create a “one-stop shop” for mental health services.
Genesis, serving about 225 clients, administers methadone and buprenorphine to help people break their addiction to heroin and other opioids. Intensive counseling and detoxification services also are provided by the county treatment program.
“I have not been made aware of it,” former Modesto Councilwoman Kristi Ah You said Monday about the closing. Ah You is a member of the county’s Opioid Safety Coalition and is deeply involved with advocacy work with mothers who have lost adult children to fentanyl poisoning. The former councilwoman appears on a television spot talking about the fentanyl menace.
Fentanyl, a synthetic opioid, is extremely dangerous. Ingesting a tiny amount can be fatal.
“We have so few programs for those suffering from substance abuse disorders and I can’t imagine why we would close a program like that,” Ah You said. “We don’t have detox facilities in the community. We are sorely lacking in treatment centers for people who are desperate to get over their addiction.”
Lyn Raible, a former medical director for Aegis medication-assisted drug treatment clinics, criticized county leadership for not discussing the closure of Genesis with relevant people or groups dealing with the opioid epidemic. Raible said she found out about Genesis’ pending demise Wednesday, the day after the board decision.
“They did none of the things to assess the impact this will have,” Raible said. “It’s not just that you are uprooting (patients) from a program that is well established, you are uprooting them from their counselors. Stanislaus County has come an enormous distance in how it responds to the opioid crisis, and this runs counter to the progress that we’ve made.”
Six years ago, Raible pushed for adding a second Aegis treatment clinic in Modesto because the one on McHenry Avenue was overwhelmed by demand. The clinic had 300 or more people on a waiting list, some of whom died waiting to get approved for service.
After fighting the stigma surrounding methadone clinics, Aegis was able to open a clinic in Ceres and is working on a service location in Turlock.
The additional capacity at the privately owned Aegis clinics is a chief reason county supervisors approved the plan last Tuesday. Moving the clients from Genesis to Aegis will come close to taking up the extra capacity created at the local Aegis clinics.
Aegis currently serves 834 clients at the Modesto clinic, which has a 1,000-person licensed capacity, and 230 of the 300 slots in Ceres are filled, according to a county staff report.
In 2022, 156 people died from drug overdoses in Stanislaus County, according to a preliminary count. That includes 113 due to fentanyl. That is more than the 95 fentanyl deaths in 2021, when the county had a total of 176 fatal drug overdoses.
Dr. James Kraus, medical director of the Genesis program, said the county clinic does more than provide methadone, which serves to quiet the cravings for heroin or other addictive drugs while a person works through the recovery process with a substance abuse counselor. The county program also includes case management, referrals to other mental health services and even help with getting connected with a primary care doctor, the medical director said.
Kraus said he hopes the general public isn’t fooled into thinking of methadone treatment as a stigma, simply substituting one drug for another. “Methadone has been shown over 50 years to get the best results, to keep people with addiction off the street, out of jail, in a job and help them get their kids back.”
He said well-managed methadone clinics are far better than addiction programs that emphasize abstinence only. “Those programs have a high relapse rate,” Kraus stressed.
County defends decision
Tony Vartan, director of county Behavioral Health and Recovery Services, said the county department could not notify staff, clients and other interested parties until the Board of Supervisors approved the facility plan and program closure last Tuesday.
Vartan said Monday that BHRS is starting to notify Genesis clients this week. Clinic staff members were told Wednesday, the day after the county board approval. Transitioning the patients and closing doors likely will take three months, Vartan said.
He said the county has contracted with Aegis since 1998 and has enough capacity under that contract to shift drug-addicted clients from Genesis to Aegis. The county said there other private medication-assisted drug treatment programs in the state, though none of those are in Modesto.
Vartan said BHRS needs to dedicate staff time and resources to implement new services under the Drug Medi-Cal initiative.
“We continue to look at new strategies to ensure we have a variety of services for substance abuse,” Vartan said. “The system will continue to grow. We are not shrinking the system.”
The Genesis program, which opened in 1983, is in a building that dates to the 1930s and was last renovated in 1978. Vartan said moving Genesis to a new location would be challenging. BHRS would need to transfer clients temporarily to Aegis, for two or three months, while the county builds and recertifies a new location, and then move the patients back to Genesis care.
“It would be disruptive,” Vartan said.
The county has emphasized that Genesis is one of only three county-operated methadone treatment programs remaining in California.
“All of our clients are going to get the same or better service than what the county is going to provide,” Supervisor Terry Withrow said. “We are not alone in our thought that it’s better to contract for these services than do it ourselves.”
What’s on the horizon?
Raible said she’s concerned the county is closing the program without getting input from staff and the program’s medical director. “The board made a poorly informed decision by ignoring this population and those who care for them,” she said by text.
The county plans to reassign the 15 to 20 staff members who work in the Genesis program to other BHRS offices.
Supervisor Vito Chiesa said at last week’s board meeting that the county needs to understand there is potential net impact of moving people who need addiction services to a new location. “I do want to make sure we are in constant communication with (Aegis),” Chiesa said.
New Jersey-based Pinnacle Treatment Centers acquired Aegis clinics in California in 2020, expanding Pinnacle’s substance use treatment services to 28,000 patients daily. Pinnacle did not return messages seeking comment.
Raible said Stanislaus County faces an uncertain future with opioid addiction. The county and other parts of California are certain to experience the miseries of “tranq,” or fentanyl laced with an anesthetic for farm animals.
The illegal drug is wreaking havoc on the East Coast and causes severe skin abscesses on users.
“It will come here eventually,” Raible said. “When we have increasing opioid deaths in the county, we still need more outreach and treatment.”
