BY ANDY GARDNER
North Country This Week

CANTON -- St. Lawrence County legislators heard proposals from three entities on operating a methadone clinic in the county, all of whom are proposing their sites be located in Massena.

St. Lawrence Health System, St. Joseph’s Addiction Treatment and St. Lawrence County Community Services all gave pitches to the board’s Services Committee during a Monday, Sept. 21 meeting streamed online via YouTube.

People being treated with methadone for substance abuse disorder currently have to travel to either Watertown or Plattsburgh to get the medication. Massena is roughly halfway between the two. Patients in St. Lawrence County living the farthest from Massena will still save time from having to travel to either of the two current locations. Legislator Kevin Acres, R-Madrid, said he has heard of some patients having to go as far as New York City for methadone treatments.

All three providers also said they would plan to dispense the methadone in individual liquid doses to prevent diversion. The liquid methadone would be dispensed from a metered machine that gets rid of most human error, and gives the exact amount each time. All three also said their facilities would be secured, with the drugs kept in a safe that meets Drug Enforcement Administration (DEA) regulations.

St. Lawrence County Community Services Proposal

Sheena Smith, clinical director for the county’s Chemical Dependency Clinic Program, said her department’s research shows they can provide the much-needed service, and turn a profit.

Her presentation showed an expected profit of $71,267 in the first year, and over $523,000 in the second year. There is a possible $900,000 grant to help start a methadone clinic here, if the county is approved. Smith said they would still be ready to move forward if the grant doesn’t come through, but they would ask for an additional $50,000 to pay for specialized equipment.

“It’s not an inflated number, it’s very actual,” she said.

Her slideshow said that the county would directly oversee its methadone program, and ensure that “program expenses are fully offset by federal revenues,” according to a slideshow she showed to the committee.

Smith said the Community Services Department linked up with “mentor agencies” that have experience with a methadone program, also called an opioid treatment program, or OTP for short.

She said the county is tentatively eyeing a building on Harrowgate Commons in Massena, which currently houses the county Probation Department and Department of Motor Vehicles. There are strict federal guidelines for how an OTP clinic has to be set up and secured. Smith said the landlord of that building also built the nearby Homeland Security Investigations office, and has materials left over that will meet the standards. They just need to come up with a DEA-compliant safe, and ballistic glass for the dosing window.

Clients would enter and exit through a separate entrance on the western side of the building, facing trees.

Smith said they would plan their dosing hours from 7 p.m. to midnight. That’s because 80% of their current clientele on medication-assisted treatment (suboxone) are unemployed. She said they could revisit the hours if they get more working people involved in the OTP.

Smith added that the county does not turn people away because they can’t pay, and does not dismiss clients who relapse or don’t adhere to their treatment program.

“Being kicked out of treatment doubles the risk of overdose for our clients,” she said.

She also noted that in 2019, they served 2,650 unique clients.

“We are the oldest and largest outpatient addiction treatment program in the county,” Smith said.

Part of Smith’s presentation was unintelligible due to a technical glitch on the county’s livestream. A feedback loop between the board room’s Zoom microphone and Smith’s Zoom microphone made it impossible to understand a small part of her presentation. County tech workers were able to resolve the issue after several minutes.

St. Lawrence Health System Proposal

St. Lawrence Health System would put their methadone clinic in the St. Lawrence Centre mall, and renovate a former retail space to meet the DEA standards.

Jamie Smith, behavior health service line director for SLHS, gave their presentation.

Their plan would be to place their clinic in a 5,000-square-foot former retail space in the St. Lawrence Centre mall, across from the Veterans Affairs clinic.

“We’re going to set up our program to be very similar in the way they have confidentiality protections,” she said, adding that they will have solid walls facing the inside of the mall, and discreet signage.

They are planning to dispense methadone six days per week from 5:30 to 10:30 a.m.

“We will not have lines. We want people to come in, get their medications, and go to work or whatever they need to do that day,” she said.

She said there will be no denial of service based on prior treatment history or current toxicology.

“We don’t talk about discharges anymore,” Jamie Smith said. “We talk about level of care transitioning or continued care.”

She said that they are planning on taking a loss in the first year, and turning a profit starting in the second year. She said they’re willing to absorb the loss to provide a life-saving treatment.

“I think the people of our county deserve this service,” she said. “This is life or death. Our patients, if they don’t get the care they need, they easily die.”

She anticipates it would be six months to a year before they are up and running.

“It’s so heavily regulated. I don’t want to say too much and not be able to deliver based on us, but based on federal regulations and everyone who needs to give the say-so,” Jamie Smith said.

St. Joseph’s Addiction Treatment Proposal

The St. Joe’s presentation came from CEO Bob Ross, Medical Director Dr. Hector Biaggi and Chief Clinical Officer Zachary Randolph.

Randolph said they currently have an outpatient clinic in a building on the Massena Hospital campus, and they would put their methadone clinic there, with its own separate entrance and exit.

“We wouldn’t need any extra or additional signage. It would be discrete, it would stay local,” he said.

He said their hours would be “sometime between 6 a.m. and 9 p.m.”

“That’s a starting point. We’d start there with the timeframe and if we need to adjust it, we’d adjust it as we saw need,” Randolph said.

Ross added that he believes they would be up and running in six to eight months. On top of that, they’re planning on opening their own detox center sometime next year in Saranac Lake. St. Lawrence Health System also operates a detox center in Gouverneur.

“What we’re trying to do is provide that continuum of care … sustain and support individuals walking their recovery out,” Ross said.

He said although they won’t need to make many renovations to the space to meet DEA standards, they can’t guarantee that they would be able to proceed if the $900,000 grant doesn’t come through.

“If the county does not get the $900,000 … in the middle of state cutbacks and covid crisis … the answer to that is no,” Ross said in response to the question from Legislator John Burke, R-Norfolk. “We believe the county is in a position to get the $900,000 grant. We’ve already spent some time and energy and money on our part.”

Legislator Joe Lightfoot, R-Ogdensburg, asked Ross what sets them apart from St. Lawrence Health System.

“It’s not so much that we are better than another applicant. It’s what we do well and what we’d attempt to do well here, in this particular service,” he said. “We do not run a hospital … we feel we can provide services within our continuum of care that are more cost-efficient. It’s not easy in hospitals to keep your costs down.”

Ross added that they’ve been offering treatment services for 49 years, and since then have added services specific to veterans and adolescent.

He said they also have their own vans to take patients to and from appointments.

Dr. Biaggi noted that they currently serve somewhere between 150 and 200 patients at their Massena outpatient clinic that dispenses suboxone. He said most are stable, and about 5 to 10% might be candidates for methadone.

“The longer conversation for us to have with the individuals on [suboxone] … are they able to maintain a quality of life?” Randolph said. “I think it’s largely a case-to-case conversation.”

The board took no action with regard to the methadone program. They may revisit it at the September Finance Committee meeting.