Pamplin Media Group
Eighty-eight people in Clatsop, Columbia and Tillamook counties received methadone through the Oregon Health Plan last year to help treat heroin or prescription opioid addiction.
The drug cost $87,972. The cost of travel to the Portland metro area for treatment? $725,758.
“It’s astonishing,” said Leslie Ford, the director of clinical innovation at Greater Oregon Behavioral Health Inc., which helps administer drug treatment and mental health care in several rural counties.
Motivated to lower travel costs, and to treat people for drug addiction where they live, regional health care administrators are scouting locations for a methadone clinic in Clatsop County.
Underwritten by the Columbia Pacific Coordinated Care Organization, which oversees the Oregon Health Plan in the three counties, the methadone clinic would likely be operated by CODA, a Portland-based drug treatment provider.
“I think that what people underestimate is how much is happening already in the community and it’s just badly treated,” Ford said.
Methadone is a powerful pain reliever that mimics some of the same effects as heroin or prescription opioids and eases withdrawal symptoms. The drug, approved by the U.S. Food and Drug Administration to treat heroin addiction since 1972, is prescribed for at least a year and often much longer to reduce harm as addicts move from treatment to recovery.
Medication-assisted treatment has been embraced by the U.S. Department of Health and Human Services as having the highest probability of success for people addicted to opioids. In Clatsop County, Clatsop Behavioral Healthcare and Columbia Memorial Hospital have partnered since June on a treatment option at a Warrenton clinic that combines behavioral counseling with Suboxone, a drug used to help lessen the cravings for heroin or prescription opioids.
Methadone is more addictive, and more likely to be abused, than Suboxone, which is why doses are mostly given daily at methadone clinics instead of prescribed once or twice a week for people to take at home.
Even as opioid abuse has reached epidemic proportions in the United States, the image of drug addicts lining up at a methadone clinic every day is too much for some communities.
“We definitely want the support of the community, as much of it as we can get,” Ford said. “And we realize we’re not going to get all of it.”
Warrenton Mayor Henry Balensifer does not want a methadone clinic in Warrenton.
The city is already home to the Suboxone clinic and the crisis respite center, which helps people in mental health crisis. The mayor believes a methadone clinic would place another layer of stress on police.
Balensifer also has ideological objections to substitution treatment — replacing heroin or prescription opioids with methadone, with no time limit on a cure.
“I think that if we’re going to invest money into getting people help, then it should be to get them out of addiction,” he said. “And methadone has got a pretty bad reputation over the years, and it earned that reputation.
“So I’m not excited to bring additional potential problems to the city.”
Balensifer said if the idea is “simply risk reduction, we’re not doing anybody a favor other than subsidizing someone’s drug habit in a cleaner manner.”
Astoria Mayor Arline LaMear said drug treatment options are worth pursuing, but she does not know the best place for a methadone clinic. She noted that Helping Hands, a Seaside-based nonprofit that works with people who are homeless or struggling with drug and alcohol abuse, chose a former Uniontown boarding house for a new facility because it is closer to other social services in Astoria.
“But I don’t know that citizens are going to be thrilled about having it here in Astoria, either,” she said.
Sheriff Tom Bergin and District Attorney Josh Marquis were skeptical last year about the county’s needle-exchange program, but they agreed not to try to block approval. Needle exchanges and methadone clinics are practical approaches that treat drug addiction as a disease, yet can be in conflict with the zero-tolerance view of illegal drug use often expected of law enforcement.
Drug abuse, and the lack of treatment available locally for people on the Oregon Health Plan, is intertwined with crime and contributes to overcrowding at the county jail.
“I’m for treatment as long as we can get people back on the track of being, I guess, productive citizens in our community. And if that’s what it takes, then fine,” Bergin said of a methadone clinic. “I’m not a big fan of methadone unless it’s something that can be utilized to wean people off the addiction. I know it’s a long, hard process, but it needs to be done, it’s not something that should be just maintained.
“I think there needs to be goals involved with that type of treatment. In other words, you need to reach milestones. And they need to be reached methodically and clearly.”
Marquis said CODA, which will likely run the methadone clinic, has an impressive reputation. The provider, which has been involved in methadone treatment for decades, has participated in national research on addiction and recovery.
“I am supportive of it,” the district attorney said, “because I think it’s unrealistic, when people are in addiction, to expect that the only alternative is abstinence.”
Round trips from the North Coast to the Portland metro area, and in some cases, Salem, for methadone can be disruptive for people trying to shake drug addiction. Spending eight times more money on travel than treatment is also unsustainable for the Oregon Health Plan, the state’s version of Medicaid.
Geographically, Clatsop County is in the middle of the three counties under the umbrella of the Columbia Pacific Coordinated Care Organization. Ford said administrators are looking at locations from Astoria to Seaside for the methadone clinic, with an eye toward property that offers some sense of privacy.
“We’re serious about doing it,” she said, “because we think it’s a really important addition to the addictions treatment ecosystem.”