HomeMy WebLinkAbout2016-08-08 16-290 Council Documents (14) August 1, 2016
• Penobscot Metro's Fulfillment of
Criteria in Chapter 93
The following reviews the criteria set forth in Ch. 93, Bangor's Ordinance for Chemical
Dependency Treatment Facilities. This summary lays out key points in Penobscot Metro's
June 6, 2016 application that demonstrate fulfillment of the pertinent criteria, supplemented by
more recent information in certain instances (waitlist, etc.). It includes additional material and
references supplementing the handout we shared with the Council at its July 11 meeting.
93-5.A. The property is adequate to accommodate the proposed increase, including
providing sufficient interior space to avoid patient queuing on sidewalks,parking area, and
other areas outside of the facility.
• Location at 659 Hogan Road—Maine Square Mall—close to Bangor Mall and other
retail and service establishments;
• 6,250 sq. ft. of first and second floor office space where facility has been for 11 years;
• Significant construction upgrades involving investment of$600,000—construction
upgrades now include sufficient office space to accommodate:
• 11 counselors;
• • Clinical supervisor;
• Medical Director;
• Separate office for Nursing Department;
• Up to three rooms to provide for groups of our patients;
• Drawings with room configurations and improvements will be shown to the Council;
• Two more dosing windows to provide a total of 4 dosing windows to improve patient
flow;
• Ramp-up to 500 patients will be gradual, increasing by 8 to 16 patients per month;
• 120 patients on typical day with 40% arriving before 8:00 a.m.;
• Parking is sufficient under § 165 of Bangor Code per March 26, 2016 sign-offs of
multiple Certificates of Occupancy;
• Traffic flow has been coordinated;
• • Dosing hours are from 5:15 a.m. to 11:30 a.m.;
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III • Security personnel on duty at all times—two typically on duty.
93-5.B. The treatment program is able to hire and retain adequate numbers of
qualified staff to meet applicable state and federal standards of care.
• Over the past 11 years, Metro has been able to hire and retain needed professionals to
meet all state and federal standards and regulations;
• Have several medical and treatment professionals, including:
• 8 substance abuse counselors;
• 1 certified clinical supervisor;
• 1 registered pharmacist;
• 3 licensed physicians;
• 3 dispensing nurses with registered nurse manager;
• 3 security persons;
• 1 Program Director;
III • 20 full-time and part-time subcontracted employees;
• Each of the treatment professionals meets all state and federal licensing
requirements and practice respective disciplines;
• Now have 8 counselors—will ultimately need at least 10 upon full ramp-up to 500;
• Metro will hire 3 additional counselors upon receipt of approval so that regulatory
ratio of at least one counselor to each 50 patients continues to be met—the standard in
the regulations [other facilities have found it necessary to seek and obtain waivers to
go to ratio of 150 clients to each counselor—but Metro has always been within the 50
to one standard—and 35 to one for counselors in first year].
93-S.C. The applicant has demonstrated a need for increased services that cannot be
reasonably met except by the increase in the permitted number of patients at its existing
location.
• Total census now 300 and has been 300 over the past few months;
• Waitlist of 173 patients as of June 6;
• Updated waitlist based on call backs over past 2 weeks—see update below under
III93-6 review of fulfillment of this criterion;
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• • Three to five individuals contact daily seeking treatment;
• Many on waitlist have been waiting over 120 days to be admitted;
• Dr. Patel notes Public Health Epidemic:
o May 2 Fox 22 Report on 2 deaths from dangerous batch of potent heroin;
o Bangor Daily News reported on March 7th this year that 272 individuals had died
in 2015 from heroin overdoses in Maine—a 31% increase from the previous year.
Portland Press Herald July 8 article titled Planfor'social detax'center in Bangor generates
debate contained the following:
Maine is in the middle of an opioid epidemic, with 272 people dying of a
drug overdose in 2015, the most ever. Meanwhile,people are clamoring
for treatment, but there's skyrocketing demand and a limited supply.
About 25,000 to 30,000 people want to enroll in drug treatment programs
in Maine but do not have access, according to the U.S. Centers for
Disease Control and Prevention. The state currently has a capacity to
serve 4,300 opioid patients with medication-assisted treatment, according
to an estimate by the Maine Opioid Collaborative, a group that worked for
more than a year to devise a statewide strategy on how to address the
111 opioid crisis.
§93-5.D. The applicant is in compliance with all state or federal laws, rules or
regulations regarding its opioid treatment program.
• Metro has all required state and federal certifications, licenses, etc.;
• Opioid Treatment Certification from U.S. DHHS Substance Abuse & Mental Health
Services Administration;
• Controlled Substances Registration Certificate from DEA;
• Certificate of Licensure from Maine DHHS;
• Three year accreditation from Commission on Accreditation of Rehabilitation
Facilities;
• June 16, 2016 e-mail from Sarah Taylor, Asst. Director of Maine DHHS DLRS
confirming that DHHS will approve increase in slots following approval from City of
Bangor.
93.5.E. The applicant is in compliance with all City codes and ordinances.
. • Metro is now in compliance with all City Codes and Ordinances;
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• Recent construction complies with City requirements per March 26 Certificates of
• Occupancy;
• Certificates of Occupancy document fulfillment of parking and all related criteria set
forth in City Code that are generally applicable to medical treatment facilities;
• City fire inspections have been successfully carried out.
93-6. Geographic location allowed for consideration. Notwithstanding the
provisions of§93-5 above, the City Council may consider the geographic locations of patients
and potential patients and may deny the application if it determines that there is sufficient
patient demand to warrant a treatment facility in an area geographically closer to current and
potential future patients.
• Geographic distribution of current patients shows 88%from Penobscot, Hancock and
Waldo Counties
Penobscot: 201 (67%)
Hancock: 42 (14%)
Waldo: 23 (7.33%)
Piscataquis: 12 (3.99%)
Washington: 5 (1.66%)
Somerset: 5 (1.66%)
• Aroostook: 4 (1.33%)
Knox: 2 (.66%)
Lincoln: 1 (.33%)
• More than two-thirds of our current patients live in Penobscot County, and over 88%
live in Penobscot and the adjoining two counties of Waldo and Hancock;
• Notable regarding patient distribution by cities and towns are the following:
Bangor: 62
Brewer: 12
Hermon: 11
Old Town: 14
Winterport: 10
Milford: 18
• See Tabs 10 and 11 for application for further breakdowns;
• Over the past couple of weeks, Penobscot Metro staff reached out to all those on
waitlist to seek residence information. Staff was able to reach 60 prospective patients
who confirmed that they were ready to enter treatment at the clinic. They provided
the following additional information regarding their residence:
•
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• Totals
Prospective Patients Stating Ready to Enter Treatment-- Total of 60
Those stating residences—52
Those with no stated residence—8
Penobscot County Cities
Bangor—22
Brewer—2
Old Town—3
Penobscot County Towns
Corinth— 1
Eddington— 1
Howland— 1
Lincoln—3
Medway— 1
Milford—3
Millinocket—4
110 Total residing in Penobscot County—41 of 60 --68% --79% of those stating
residence(41 of 52)
Waldo County
Belfast— 1
Winterport— 1
Hancock County
Ellsworth—4
Bar Harbor— 1
Bucksport— 1
Piscataquis County
Guilford— 1
Washington County
Calais— 1
IIIMachias— 1
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• Colonial Evaluation of Other Sites
The parent of the Penobscot Metro Clinic, Colonial Management, is evaluating the
potential for other clinic sites in Maine.
• Particular consideration is being given to a site in Aroostook County with different
locations being evaluated—Houlton or Presque Isle look most promising;
• While Metro's current census includes only four patients from Aroostook County,
Colonial is aware of significant treatment needs in Aroostook County and the barrier
to treatment that travel distances pose—no doubt there are many others seeking
treatment in Aroostook county and other points north of Bangor;
• There is no timetable for Colonial's reaching a determination on additional clinic
sites, but Colonial agrees with the importance of providing treatment sites closer to
client's communities and is giving serious consideration to additional sites;
• At the same time, Colonial has already made the investment and has carried out the
needed construction to meet the current waitlist and currently identified need of
prospective patients seeking treatment at its Penobscot Metro clinic.
Methadone Treatment Background
• In the attached Notebook,please see the material set forth under the following tabs:
4. Penobscot Metro Chart Comparing Maine DHHS Substance Abuse Regulations for
Outpatient Treatment Programs with the Office of Substance Abuse Waiver and
Proposed MaineCare Manual Regulations Subject to Public Hearing on July 11
(DocID No. 10786804)
5. Penobscot Metro Typical Patient Scenario (DocID No. 10786567)
6. New England Journal of Medicine (NEJM Article), July 28, 2016, Treatment of
Opioid-Use Disorders, Marc A. Schuckit, M.D., (DocID No. 10793409)
http://www.nejm.org/doi/ful1/10.1056/NEJMral604339?query=TOC
7. NIDA(National Institute for Drug Abuse) International Program—Methadone
Research Web Guide—Part B—Questions and Answers Regarding Methadone
Maintenance Treatment Research (DocID No. 10747358)
https://www.drugabuse.gov/sites/default/files/pdf/partb.pdf
8. U.S. DHHS Substance Abuse and Mental Health Services Administration
(SAMHSA)—Website Summary of Materials Regarding Methadone and Related
Treatment http://www.samhsa.gov/medication-assisted-treatment
• a. Methadone Treatment—What is Methadone, How Does Methadone Work, etc.
(DocID No. 10747302)
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• http://www.samhsa.gov/medication-assisted-treatment/treatment/methadone
b. Medication and Counseling Treatment and Opioid Treatment Programs (OTPs)
(DocID No. 10747334)
c. Medication Assisted Treatment(MAT)—Buprenorphine Options, Among Others
(DocID No. 10747345)
d. Buprenorphine—How Buprenorphine works, etc. (DocID No. 10747331)
NEJM Article Overview
The NEJM Article stated as follows at p. 363 with respect to Methadone Treatment:
Methadone Maintenance Approaches
Maintenance treatment with methadone, an oral mu agonist, has been widely used
and intensively studied worldwide. In the United States, methadone is offered only
through approved and closely monitored clinics that initially require almost daily
patient participation in order to receive the drug, although some take-home doses
are usually allowed for patients who adhere to program guidelines.
• To be eligible for methadone maintenance,patients must have a current opioid-
use disorder with physiologic features or have high risks associated with relapse
(e.g., during pregnancy). In addition,patients cannot be currently participating in
another maintenance program and cannot be especially vulnerable to methadone-
related medical complications (e.g., they cannot be dependent on a depressant
drug or have severe respiratory or cardiac disease). Dangers associated with
methadone include overdose if the dose is increased too quickly during the initial
stages of treatment and a potential prolongation of the QT interval on
electrocardiography that can contribute to cardiac arrhythmias with doses higher
than 100 mg per day. 44-46 Patients must understand their roles and
responsibilities as well as the benefits that the program can and cannot offer.
Methadone maintenance treatment occurs in approximately three phases (Table
5).47 The induction and early stabilization phase (beginning at week 1 and
continuing in week 2) begins with initial oral doses of 15 to 30 mg, increasing by
10 to 15 mg every 3 to 5 days to 50 to 80 mg per day. During the late stabilization
phase (at approximately weeks 3 to 6), doses are increased as tolerance develops
and craving decreases. The most effective dose is 80 to 100 mg per day. 47-50
•
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. Patients who receive more than 100 mg per day must be closely monitored for
side effects. 44,46,50
The maintenance phase begins at approximately 6 weeks, with doses adjusted to
avoid drug-related euphoria, sedation, or opioid craving. Methadone clinics must
be open on weekends in order to meet the needs of most patients, 51 and weekend
take-home doses are based on the patient's progress in treatment and
determination that he or she is unlikely to divert medications to other persons.
The length of the maintenance phase, which depends on the patient's progress in
treatment and his or her motivation, can last years to a lifetime.
1 Tapering off methadone is individualized and may take weeks or months. 26
During and after tapering, close contact with the patient should be maintained
because discontinuation of maintenance carries high risks of relapse to the use of
illicit drugs and overdoses that may lead to death. 11,52,53
The effectiveness of methadone maintenance is well established, and this drug is listed
among "essential medications" by the World Health Organization. 11,45 Maintenance
programs decrease mortality by approximately 50%among persons with opioid-use
. disorders, decrease acquisition of HIV infection and hepatitis, decrease crime and illicit-
substance use, improve social functioning, and increase the rate of retention in
rehabilitation programs. 15,50,54,55
Methadone and Crime
See Tab 7 in the attached Notebook, the NIDA Document, 20 Questions, Question 4, Part
B-20—Does methadone maintenance treatment reduce criminal activity? This reviews
extensive research and notes; "The availability of methadone treatment in a community is
associated with a decrease in that community's criminal activity, particularly theft."
See, also Tab 9:
9. Addiction Research Report, Use of a"Microecological Technique"to Study Crime
Incidents Around Methadone Maintenance Treatment Centers, Boyd et al.,
Department of Psychiatry, University of Maryland, Baltimore, February, 2012.
(DocID No. 10736922).
This Study concluded that"Methadone treatment centers, in contrast to convenience
stores, are not associated geographically with crime."
.
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• Methadone and Societal and Economic Costs from Lack of Treatment
See Tab 7 in the attached Notebook, the NIDA Document, 20 Questions, Question 18,
Part B-55-59—Are there cost benefits to methadone maintenance treatment. This reviews
extensive research and notes"Research has demonstrated that methadone maintenance treatment
is beneficial to society, cost effective, and pays for itself in basis economic terms."
A 1991 NIDA Study of the yearly costs to maintain an opioid addict in New York
determined relative economic costs to be: $43,000 for an opioid addict untreated and on the
street(crime-related costs and security); $34,000 in prison; $11,000 in a residential program; and
$2,400 in a methadone maintenance program.
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