State officials and nonprofit providers are spending millions of dollars to increase access to methadone in Connecticut and to eliminate one of the biggest barriers to that opioid treatment medication: travel times.
Several of the state’s methadone providers are in the process of siting and opening new methadone treatment centers in Connecticut, including the first clinic of its kind in Middlesex County.
At the same time, state officials are preparing to spend more than $4 million from a pool of opioid settlement funds to outfit two new methadone vans, which will be capable of dispensing the vital medication to patients in more isolated corners of the state.
Those investments are key to Connecticut’s larger goal of expanding medication-assisted treatment in the state, including methadone, which is widely considered to be the most effective treatment for people with a history of using heroin, fentanyl or prescription painkillers.
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There are roughly 30 inpatient clinics located throughout Connecticut that dispense methadone to individuals seeking treatment for opioid use disorders.
But with many of those federally licensed centers located in the state’s larger cities, there is concern that pockets of Connecticut still don’t have a level of access that is necessary to combat the ongoing opioid epidemic, which claimed the lives of more than 6,300 Connecticut residents in the past five years.
To highlight that point, a team of researchers from Yale University and Virginia Tech University recently completed a study for Connecticut that calculated how long it takes for residents in every part of the state to travel by car, bus or train to the nearest methadone clinic.
That analysis showed that for people living in and around cities like Waterbury, Hartford, Danbury, New Haven, Bridgeport, Stamford, Torrington, Norwich and New London, it often takes less than 15 minutes by car to get to the nearest methadone clinic.
But in other sections of Connecticut, it can take more than 45 minutes to drive to the closest treatment center, which can be a major impediment for people who are undergoing methadone treatment while also attempting to maintain a job or care for their families.
“Imagine being stuck in traffic, knowing you have to get dosed and you have to get back to work or you have to get your kid on the school bus,” said Nancy Navaretta, the Commissioner of the Connecticut Department of Mental Health and Addiction Services.
Unsurprisingly, the time commitment is even bigger for people who don’t have access to a car.
Large swaths of Connecticut have no public transportation, and even in places that do, the researchers found, it can take more than two hours in some instances for people to get from their homes to a methadone clinic via public transit.
During the early stages of methadone treatment, patients are often required to travel to the clinics daily for therapy and their liquid dose of methadone, which helps to reduce the most severe symptoms of opioid withdrawal.
Benjamin Howell, one of the Yale researchers who conducted the travel study for the state, said that means some people who are in the initial phases of treatment could spend three to four hours per day on a bus just to receive their medication.
That can be a major deterrent for people suffering from the most serious opioid use disorders, Howell said, because illicit narcotics like heroin and fentanyl can be more easily available to those individuals than the medication-assisted treatment.
“These are the people we should be championing — the people who are deciding to go get treatment,” Howell said. “We should be supporting those people as much as we can and lowering the barrier as much as we can.”
The long commute
Doug Schumann knows all too well the burden that travel times can present when attempting to access methadone treatment in Connecticut.
From 2015 to earlier this year, Schumann has been making the journey from his home in Middletown to a clinic in Hartford operated by the Root Center, the state’s largest methadone treatment provider.
Schumann wasn’t excited about making the 20-mile commute six days a week. He did so because, for the past nine years, the Root Center’s clinic in downtown Hartford was the closest medication-assisted treatment center available to him.
Schumann, who became dependent on opioids after initially being prescribed painkillers to treat the symptoms of pancreatitis, said during the first couple months of his methadone treatment in 2015, the distance between his home and the Hartford clinic was extremely difficult to overcome.
The car he was using broke down shortly after he began making the half-hour commute. That setback resulted in him taking a three- to four-hour round-trip bus ride to Hartford for more than a month, which was a major hassle while he was in the nascent stages of recovery.
Schumann said he was able to overcome the significant commute time by forming a daily routine, which required him to get up before dawn so that he could reach the treatment center by 5:30 a.m.
“It took me a long time to get where I am now,” he said.
But other Middletown residents who sought out treatment did not have the same success that Schumann did when faced with the prospect of traveling to clinics in Hartford, New Britain or Manchester every day.
“A lot of people that I know have dropped out because of the distance,” Schumann said.
Filling the gaps while fighting the stigma
The commute for Schumann and other people living in and around Middletown got a lot easier in April, after the Root Center began accepting patients at the first methadone clinic in Middlesex County.
The opening of that new center, along Washington Street in Middletown, will fill one of the biggest geographic gaps in methadone treatment in the state and ensure every county in Connecticut has at least one clinic capable of dispensing the highly regulated medication.
The travel study produced earlier this year showed that residents who lived along the lower Connecticut River valley in towns like Chester, Haddam and Lyme previously faced more than half an hour in a car or two hours on a bus to get to the nearest methadone clinics.
Steven Zuckerman, the executive director of the Root Center, said those travel times should be dramatically reduced now.
The creation of the new clinic was not easy, however. It took more than five years and a lawsuit against Middletown’s Planning and Zoning Commission to get permission.
The Root Center committed a substantial amount of time and money to building the treatment center, Zuckerman said, because the organization knew there was an unmet need for opioid treatment in the region.
That is reflected in the Root Center’s current list of patients. Zuckerman said his organization has 180 patients with Middlesex County addresses who have been travelling to the organization’s other clinics in Hartford County.
We’ve been stuck in this situation where it’s been stigmatized for so many years.
Doug Schumann
Some of those patients, he said, testified during earlier meetings of the Middletown Planning and Zoning Commission about the need for a clinic in Middlesex County and the benefits it could provide.
But in return, Zuckerman said, those patients were met with “brutal comments” from other members of the public, who openly disparaged people who were receiving treatment for an opioid use disorder.
That type of local opposition to methadone treatment centers in Connecticut has not gone away.
A group of residents in Guilford is fighting a newly proposed clinic being constructed in that town by the APT Foundation, another nonprofit treatment provider headquartered in New Haven.
Despite the local zoning laws allowing the center to operate there, the opponents of that new clinic continue to complain about its proximity to homes and schools.
In response, Guilford’s first selectman and the executive director of the APT Foundation said the patients who will access that clinic already live in Guilford and surrounding communities. But that has done little to quiet the opposition.
The recurring complaints are representative of the wider stigma that surrounds the opioid treatment drug, several providers and methadone patients told The Connecticut Mirror.
“We’ve been stuck in this situation where it’s been stigmatized for so many years,” said Schumann.
A mobile solution
While the nonprofit providers continue to advocate for additional methadone centers in the state, Connecticut officials are working on another strategy to fill in any remaining gaps in the network.
In March, the members of the Connecticut Opioid Settlement Advisory Committee, which is responsible for managing the settlement funds, voted to spend $4 million over the next three years to help providers retrofit two vans to dispense methadone.
Navaretta, the DMHAS Commissioner, said the settlement committee chose to spend that money because it believes those roving clinics will increase the number of people who are enrolled in a methadone program and, ultimately, save lives.
“Over and over again, by various authorities, it’s been shown that medication for opioid use disorders is the most effective intervention,” Navaretta said.
DMHAS will accept bids in the coming months from licensed methadone providers who are interested in operating the vans. Agency officials said they could be up and running by sometime next year.
The state intends to give preference to treatment providers that will use the vans to cover Connecticut’s northeast corner, northwest corner, southeast corner or the central part of the state. All of those areas were identified as regions with significant commute times to existing clinics.
We wouldn’t be able to do it if there wasn’t the opioid settlement dollars to really provide seed money.
John Hamilton, president and CEO of Liberation Programs
John Hamilton, the president and CEO of Liberation Programs, which runs methadone clinics in Stamford and Bridgeport, said that without the state’s financial support, nonprofit providers like his would be unlikely to build and staff the mobile methadone vans.
The cost for the mobile treatment centers is substantial, Hamilton said, because the vehicles need to meet strict regulations required by the Drug Enforcement Administration, which polices methadone because it is, itself, a narcotic.
The vans will need a bathroom, a safe that is bolted to the vehicle and all of the equipment that is necessary to dispense the liquid methadone to patients. All of those upgrades, state officials said, could cost up to half a million dollars.
The groups that operate the vans will also need insurance and licensed nurses to staff the vehicles, which is why the settlement advisory committee also set aside money to cover operational costs for several years.
“We wouldn’t be able to do it if there wasn’t the opioid settlement dollars to really provide seed money,” said Hamilton, whose intends to apply to run one of the two vans.
State officials believe the vans could serve multiple purposes.
Luiza Barnat, the agency’s director of opioid services, said the vans will increase public awareness of methadone and other recovery services in smaller towns, and she said they should increase the number of people who stick with the treatment.
“I think the vans really provide a lot of engagement and are able to reach the people that we’re currently not reaching at all,” Barnat said.
Officials also hope the vans will be able to travel to skilled nursing facilities and long-term care centers to ensure patients no longer need to wean themselves off the opioid-treatment medication while they are recovering from a surgery, an illness or an injury.
Hamilton said all of those additional services can help help get more people enrolled in a methadone program.
That’s vital, he said, when research has shown that only a small portion of the people who could benefit from methadone are actually accessing the medication.