Government Operations Committee

August 12, 2008

Minutes

Councilors: Hawes, Farrington, D’Errico, Palmer, Stone, Wheeler, Gratwick

Staff: Heitmann, Nicklas, Gastia, Arno, Barrett

1. Council Ordinance 08-249, Amending the Code of the City of Bangor by Adding Chapter 93, Chemical Dependency Treatment Facilities

This item was originally requested by Councilor Stone. Currently, there are three providers of methadone treatment in Bangor for opioid addiction. The facilities in Bangor have the capacity to meet the needs of current and future patients, and additional facilities or capacity is not needed at this time. Other communities have, or are considering, ordinances to limit or prevent providers from locating in their communities. Patients of methadone treatment facilities place certain demands upon the municipality in which they are located.

The proposed Ordinance will limit the number of facilities to the three that currently exist and will provide a process that must be followed to seek an increase in the number of patients the facilities are currently licensed to treat.

Heitmann provided some background information dating back to 2001 when the first methadone clinic was established in Bangor. At that time, the City established a Community Advisory Group which was charged to work with the clinic providers. Since that time, two new facilities have been located in Bangor. The three facilities are licensed to treat 1,700 patients and currently treat approximately 1,200. Other communities have taken action to restrict or consider restriction of methadone clinics in their community; i.e. Brewer, Newport, Ellsworth. The State has regulations that govern clinics but has not taken any affirmative action in response to other recent community’s actions. Heitmann said that if the Council feels action is appropriate that Bangor will clearly need to do it themselves.

Heitmann noted a couple of concerns relating to the actions of other communities. Future facilities are likely to be only located in those communities where they are currently allowed: Waterville, Calais, Bangor, and Portland. The providers, if interested in locating in other communities, may have difficulty in doing so. By default, current communities with clinics may be seeing new clinics. In addition, the patients will be limited in their choices of where to receive treatment. In response to Councilor Stone’s concerns, Heitmann prepared an Ordinance that seeks to address issues that can be dealt with by Bangor. The Ordinance deals with three issues: it limits the number of facilities currently in place; no certificate of occupancy shall be granted to others; it caps the number of patients to those three facilities to what they are currently licensed for noting that none of the three facilities have currently maxed out their limit; a mechanism whereby all three facilities have the license to expand covered by a City Certificate of Need. The Ordinance also provides for public input in any proposed expansion. The City has also had a concern with the Certificate of Need and public input process. He also reviewed State required regulations. He stated that the current proposal would place a limit on the current number of facilities in Bangor, would place a limit on the permitted patient load at 1,700, and would provide the opportunity for public input in the case of future expansion, would put a process in place similar to State regulations to allow for expansion if needed and would allow the City Council to consider the geographic location of the patients or potential patients. The proposed Ordinance would be retroactive to July 1, 2008.

Hawes opened up discussion to members of the audience.

Dr. Elizabeth Weiss said her practice provides an in-office treatment for opiate addiction. She also has served on the CAG committee. She said that Bangor has been an incredible model for Maine. She feels strongly that the most powerful message to be sent to other communities is that Bangor is not afraid of the clinics. She indicated that there is more fear associated with the clinics than actual supporting data. The people to fear are not those in treatment but rather those who are not in treatment. She also disclosed that she and other individuals within her practice are working at Penobscot Metro, a methadone clinic in Bangor.

Bonnie McGinley of Howard Street said she has the utmost respect for Dr. Weiss. She believes that Bangor has positioned itself in a positive way to help many of its citizen and those in the surrounding area. Her concerns rest in the area of further homework regarding the clinics. She spoke about the rising number of sexual offenders in the Bangor area. 5 years ago there were 56 registered and now there are almost 200, and Bangor’s population has not grown. She wondered if there is a correlation with Acadia and licensed sex offenders. Before locating to Bangor, her investigation brought out the quality of life in Bangor. She asked that before the City makes a decision to increase facilities in Bangor that it should investigate her concern.

Mike McCarty, citizen of Bangor, addressed the downstream effects of the existing clinics. He isn’t certain about the Police Department’s statistics as to what percentage of crimes are connected with the three facilities. He noted that he and his family are one of the statistics after a spring burglary which was attributed to one of the clinics. He commended Stone for the proposed ordinance, and the response of the Bangor Police Department to his incident. The safety of Bangor’s citizens is paramount.

Brent Scoby, Administrator of Acadia Hospital Substance Abuse Services, said his biggest concern is that communities are locking down their areas of offering treatment to individuals who live in the more rural areas of the state. He personally does not think that Bangor would be well served by an additional methadone program. The fact that the state has taken a hands-off approach concerns him. He would like the state to take a more active approach in educating the community about the treatment programs as well as the current need in some areas of the state. Acadia has the largest methadone clinic in Maine. In 2008, Acadia hired an independent consultant to evaluate its program as it had done in 2002. The findings didn’t show a dramatic increase in crime as a result of the program’s opening. Overall, it demonstrated what has been known that the treatment ultimately works for the majority using it. The crime statistics are related to those who are not associated with a treatment clinic.

Carl ???, the Discovery House Clinic, which is Bangor’s newest facility, stated that methadone treatment is not understood. He has found that the demand is greater than what his clinic can provide. Over 50% of their patients are from Bangor, 75% from Bangor and the area, and the remaining from rural areas. Data needs to be made available so that individuals do not fear the clinic’s presence. Ten years ago he was not a supporter of the methadone clinics but he now knows that it works. He feels that the proposed Ordinance is selective and at worst it is discriminatory. It’s all about meeting patient needs.

Debbie Dettor from the Maine Alliance for Addiction Recovery said she works with individuals who are successfully recovering from addictions and who are silently moving back into the work force, are pulling their lives back together and getting well. These stories are not often told. She recently did a study with 233 individuals who are in and out of recovery and one major issue is transportation to the clinics. Some travel 6-7 hours a day to reach a clinic. She agreed that the State needs to site clinics where the clients are living.

Barrett commented that all the way through the process one of the guiding principles from 2001 and on has been the necessity for treatment to be located as close as possible to the patient. Alternative treatments offered by doctors have been supported by the City which has urged the state to work toward locating clinics throughout the state. He noted that the City of Rockland changed its mind on allowing a methadone clinic when it found it was in violation of a federal law. The City of Ellsworth has likewise passed legislation that is illegal, in his opinion, and Bangor has brought this to the attention of the State’s AG and the basic answer is that the State feels it is not their problem. Bangor worked closely with Calais town officials when they were looking into allowing a clinic. The proposed Ordinance is a wake up call to the treatment community and the State that there is a growing problem with communities closing their door and refusing to recognize their area may have a problem.

Wheeler asked Weiss if there are any types of opiates in which methadone is not effective. Weiss said that methadone is a treatment for opiate addiction. It is a long acting medication and not one that people take to become high. Over time, tolerance to it is developed. It will block the craving of an addict by filling the opiate receptors that the addict is trying to stimulate and it also will block people’s ability to get high. It allows clients to become functional. Agreeing with Wheeler, she said that there is talk about keeping addicts out of Bangor but not about keeping alcoholics out of Bangor. She feels it sends a bad message. Responding to Wheeler, Weiss said once you are an addict you are always an addict, much like an alcoholic. Wheeler asked about the take-home treatments. Weiss noted that the federal government has strict checks and balances in place and the clinics are extremely careful about keeping track of medications. It is true that there are occasions when someone who has take-home medication might be found to divert but it is a rare event.

Blanchette agreed that the people that are not in treatment are the ones to be afraid of. She feels that there is a lot of assumption that many clients are driving long distances to receive treatment in Bangor and noted that client information is not public information. She thinks that Bangor perceives an issue with the clinics with no actual proof to back it up.

D’Errico indicated he had learned a great deal from the session and evening’s discussion.

Gratwick said he favors methadone programs. His concern specifically relates to siting clinics. He thinks the State’s policy is not appropriate and it must change. He supports the proposed Ordinance. He suggested another Resolve calling upon the state to take a more responsible position to make certain that people get care closer to their homes. It is an important gesture.

Palmer spoke about the limit of the three incumbent clinics and how changes might be made or should there be three generic slots if things change in the future, the future possibility of clinics merging, and he feels the smaller communities need to be encouraged. Heitmann responded that in terms of the number of clinics, he drafted the proposed Ordinance to acknowledge that methadone treatment is an appropriate method of treatment, to acknowledge there is a need that is being met in Bangor, and even though there is sufficient capacity left under the current licensing structure in terms of numbers to be treated that there is always the potential for increased patient need. The proposed draft also includes having something in place so that the Council could review it as well as receive public input to recognize the three facilities for the foreseeable future will meet the need in this area. The draft acknowledges the need of the patient that a closer facility is better for the patient. Bangor can’t make other communities pass ordinances to allow clinics. Bangor can take care of its own, it can send a message to the State which has chosen to ignore what other communities have done and tell them that Bangor doesn’t intend to box in itself, the patients or the providers. He hopes this action will enable a lacking dialogue at the state level regarding the need of clinics and the patients throughout Maine. Bangor has a built-in Certificate of Need process by which the patient load can be objectively increased in Bangor.

Hawes said that the CAG has worked very hard with the City and she thanked the group for their dedication. Heitmann agreed also including the providers and citizens.

Responding to Wheeler, Gastia said it is very difficult to track information correlating to crimes relating to the clinics. He noted there have been incidents of people committing crimes who the Department has found to be patients of methadone clinics; however, he doesn’t know if those crimes would have been committed if the patients hadn’t been involved with the clinics. Wheeler noted his disagreement with two sections of the proposed ordinance: “certain demands” and “no more methadone clinics would be approved.” He supports every other part of the draft Ordinance prepared by the City Solicitor.

D’Errico made a motion to recommend approval of the draft Ordinance by amending it to address Councilor Wheeler’s concerns. It was seconded by Wheeler. Heitmann clarified that the motion and second is to recommend approval of the Ordinance deleting Section 93.1. Hawes agreed. He will prepare the amended Ordinance for Council consideration at its upcoming meeting. Responding to Heitmann, Hawes said the concern is with 93.1 and limiting the number of clinics. Responding to Farrington, Heitmann clarified that Sec. 93.1 indicates Bangor has three clinics and it will stay with three clinics but the motion is to eliminate 93.1 so that there is no three clinic cap. All other provisions will remain the same. Heitmann mentioned 93.3 and a patient number increase reference. He understands that the Committee seems satisfied with having any facility needing to justify the patient capacity. Wheeler suggested that the word any “existing” clinic be inserted, and he agreed that 93.3 needs to be reworked. Heitmann will prepare an alternative Ordnance for the August 25^th meeting to accommodate the motion. Stone expressed concern with the removal of 93.1. Blanchette expressed concern with placing a limit on the number of clinics and limiting patient’s choice. She said that the limits would never be placed on other medical providers. Barrett clarified that he is supportive of the clinics and the treatment. He finds it inconceivable that other communities are violating federal law. It creates a disservice.