Somerset will become a regional hub for heroin addicts undergoing methadone maintenance if the state authorizes a license for an opiate addiction treatment center here. Methadone is a synthetic narcotic drug similar to morphine but less habit-forming. It is used in narcotic detoxification and maintenance of heroin addiction.

On June 15, Terry Scott, a Pikeville businessman, filed as registered agent for Somerset Addiction Solutions, LLC, a limited liability corporation with offices at 118B Trade Park Drive in Somerset, according to papers filed with Kentucky Secretary of State Trey Grayson. Scott is also listed as agent for opiate addiction treatment centers in Pikeville and Elizabethtown.

Michelle McCarthy, State Opioid Treatment Authority Program Administrator with the Division for Behavioral Health, confirmed that her agency has received an application for an opiate addiction treatment center here.

McCarthy explained that prior to licensing, the Kentucky Inspector General must first approve a drug and alcohol treatment program for the center, and then her agency can proceed with the opiate treatment licensing process.

“Once we have received the application, there is a face-to-face meeting with the applicant,” McCarthy said.

She said that the licensing process is stringent and involves inspection of the physical facility — especially its security system — by the federal Drug Enforcement Administration (DEA). The licensing process also involves letters of endorsement from local medical, health, law-enforcement and government officials. However, unlike local option laws concerning alcohol, state law contains no provision for direct citizen input concerning establishment of methadone treatment centers.

Melissa Malone, with the Inspector General’s office, said before a license to provide alcohol or drug treatment is issued:

1. The proposed physical site of the treatment center must be inspected by the State Fire Marshal for compliance with state codes.

2. A list of medical professionals who will operate the center must be approved.

3. The center’s treatment plan must meet state requirements and fall outside treatment offered by facilities such as hospitals.

4. The DEA must inspect and approve the center’s physical building and security system.

5. A $155 license fee must be paid.

6. Full accreditation of the program does not come until after 12 months of operation and the successful compliance with state-mandated require-ments.

The Commonwealth Journal has learned that a site in a strip shopping center on south U.S. 27 may be under consideration as a location for the center. However, state officials declined to confirm the location pending a formal Open Records request by the Commonwealth Journal. Repeated phone calls to Terry Scott by the Commonwealth Journal went unanswered.

Due to south-central Kentucky’s ongoing battle against drug abuse, 5th District Rep. Hal Rogers was instrumental in organizing Operation UNITE headquartered in Somerset. UNITE works to rid communities of illegal drug use through undercover narcotics investigations, coor-dinates treatment for substance abusers, prov-ides support to families and friends of substance abusers, and educates the public about the dangers of using drugs.

Karen Engle, executive director of Operation UNITE, issued this statement concerning location of a methadone treatment center here:

“UNITE is not in favor of methadone treatment.”

Although methadone is an inexpensive drug to manufacture, it is a money maker for for-profit treatment centers such as the one proposed for Somerset. In 2003, California-based CRC Health Group paid $100 million for 17 methadone clinics operating in six states.

In 2004, Mac Bell, then state Narcotic Admin-istrator for the Kentucky Division of Mental Health and Substance Abuse Services, estimated the cost of methadone treatment in Kentucky at $85 per client per week.

“Some people may consider $85 per week overly expensive,” Bell, now retired, said, “but those people need to remember what the clients were doing before they entered treatment. We’re talking about people with $400-a-day heroin habits. In that light, $85 a week sounds a lot better.”

Methadone has an interesting history. In the 1930s as Nazi Germany’s Adolph Hitler drafted his plans for the invasion of Europe, German scientists developed methadone as a substitute for morphine and other opiates used by both the military and general civilian populations. The drug was developed in anticipation of possible shortages of raw opium during the upcoming war. It was tested by medical professionals in the German military in 1939-40.

After World War II, allied forces expropriated German patents, trade names and research records relevant to the drug.

Methadone was intro-duced into the United States in 1947 by Eli Lilly and Company under the trade name Dolophine, now registered to Roxane Laboratories. Since then, it has been best known for its use in treating narcotic addiction.

Like heroin and other opiates, methadone is highly addictive. Withdrawal symptoms are generally slightly less severe than those of morphine or heroin at equivalent doses but are significantly more prolonged; methadone withdrawal symptoms can last for several weeks or more. Taken orally once a day, methadone suppresses narcotic withdrawal for between 24 and 36 hours.

Methadone can be fatal when mixed with alcohol and/or other drugs. And despite the fact that it can impair thinking or reactions, such as when driving, Kentucky has no designated driver provisions for clients undergoing methadone treatment.

In 2005, on the heels of a $2.8 million award to the family of Jason Caldwell, who died while being treated for drug addiction, the state announced it would begin compiling data on methadone-related deaths. In a phone conversation yesterday, McCarthy declined to comment on that data. However, Pulaski County Coroner Richard New reported that only one methadone-related death was investigated by his office in 2008. (New’s complete statement accom-panies this article.)

There is a trend in the management of opiate addiction toward the reduction of a patient’s methadone dosage to a point where they can be switched to buprenorphine or another opiate with an easier withdrawal profile.

Despite the negatives of methadone treatment, the U.S. Office of National Drug Control Policy (ONDCP) has endorsed methadone treatment.

“About 20% of the estimated 810,000 heroin addicts in the United States receive [methadone treatment]. At present, the operating practices of clinics and hospitals are bound by Federal regulations that restrict the use and availability of methadone. These regulations are explicitly stated in detailed protocols established by the U.S. Food and Drug Administration (FDA). Additionally, most states have laws that control and closely monitor the distribution of this medication,” according to an official publication of the ONDCP.

According to ONDCP, methadone treatment benefits include:

• At an average cost of about $13 per day, it is considered a cost-effective alternative to the costs of incarceration.

• It has a benefit-cost ratio of 4:1, meaning $4 in economic benefit accrues for every $1 spent.

• It has a significant effect on the spread of HIV/AIDS infection, hepatitis B and C, tuberculosis, and sexually transmitted diseases. Heroin users are known to share needles and participate in at-risk sexual activity and prostitution, which are significant factors in the spread of many diseases. Research suggests that methadone treatment significantly decreases the rate of HIV infection for those patients.

In 2005, citizens of Middlesboro — with the support of private- and public-sector officials — stopped an effort to license a methadone treatment center in that city. Among their concerns was that:

1. Methadone from the clinic could end up being resold on the street.

2. The clinic would bring in a influx of known heroin addicts into their community.

3. Once a clinic is licensed, it is extremely difficult to have its license revoked should its operation prove detrimental to a community.

Lexington and Louis-ville have publicly-funded methadone clinics. For-profit clinics operate in several other Kentucky cities including Morehead, Pikeville, Hazard, Elizabethtown and Paducah.

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