Indian Time - A Voice from the Eastern Door

By Andy Gardner

St. Lawrence County legislators are considering adding a methadone treatment program to help addicts who may not be having success with the current available services.

Jay Ulrich, St. Lawrence County community services director, told the board’s Finance Committee that about 78% of the opioid-dependent patients in the county programs have such a hard time with their addiction that they can’t self-regulate a 30-day dose of a medication like Suboxone.

The discussion took place during a Monday, April 27 Finance Committee meeting held online via Zoom and streamed live on YouTube.

“About 78% of those (clients) are getting prescriptions either two or three days out,” Ulrich said. “We’re being told that indicates a higher level of care.”

Caryn White from the Credo Community Center for the Treatment of Addictions told the committee that her Watertown-based agency is already providing methadone treatment to a dozen southern St. Lawrence County residents. People in the North Country who need methadone currently need to travel to Watertown or Plattsburgh.

She said that an OTP (opioid treatment program) like Credo’s could help patients where they need a high level of care but “inpatient is not the answer.”

Credo Executive Director John Wilson told the committee that the success that can come with starting a methadone treatment program “is a very positive thing for [a] community.”

“Every couple months you see the people coming in there. They’re very physically distressed, very emotionally distressed,” he said. “Thirty, 60, 90 days later … they’re healthier, they’re happier, they’re reuniting with their families.”

White said the program, when successful, has a variety of outcomes. Sometimes, patients can stay on methadone for years, under a doctor’s supervision.

“It’s helped us to be able to keep people in treatment, keep them safe, and help them on their journey to recovery, whatever that is,” she said.

Some of their methadone clients have been coming since they started offering the service in 2016, she said.

“We also have people who have transitioned from methadone to suboxone,” she said, and some who transferred from the OTP to getting help through an outpatient clinic.

“They’re getting well, they’re getting back into the workforce, they’re getting back into their children’s lives,” White said.

Legislator Joe Lightfoot, R-Ogdensburg, asked several questions about staffing levels and security.

Wilson and White both said the staff level depends on the number of clients, but a proper balance of staffing and number of clients can lead to the service generating revenue.

White said they would, at minimum, need a medical doctor for admission assessments, “at least two additional LPNs or something like an LPN,” a clinical supervisor and “up to 50 or so patients, you need additional clinicians.” They would also need administrative staff for documentation. Some sort of peer advocacy service would need to be available, a requirement of the state Office of Alcoholism and Substance Abuse Services (OASAS). She said they would be able to apply for a waiver to replace the doctor with a midlevel provider, but the doctor would be necessary at first. And they would need to be open six days per week. On top of all of that, they would need to get approval from the Drug Enforcement Administration (DEA).

White said during dosing hours, Credo has contracted security personnel on the premises.

“You have to address … that you’re going to have potentially a lot of people coming to your clinic in a short period of time and they’re not congregating outside,” she said.

Legislator James Reagen, R-Ogdensburg, asked Wilson if Credo would be interested in expanding into St. Lawrence County.

Wilson said that’s not likely to happen, at least in the near future.

“Geographically, it would be a difficult reach for us. We’ll never turn anything down for a conversation,” he said. “Your county is very large, and to figure out, centrally, how to meet the needs of Massena, Ogdensburg, Canton … in the middle of COVID right now … there’s a lot of variables right now that make that conversation very difficult.”

Williams said that if St. Lawrence County were to open a methadone clinic, they would be able to learn from others who are already doing it and hopefully have a good rollout.

“I think if St. Lawrence County was to open a clinic, there’s a lot more advice out there now how to start up your clinic," he said.