Indiana Governor Signs Bill Supporting Tighter Regulations for Methadone Maintenance

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Swim's methadone clinic has recently implemented some changes, and she's been doing some reading on the issues. She is one who believes that addiction and dependence are to be most effectively treated as social and medical issues and approached via harm reduction, and that professionals in treatment facilities such as methadone clinics should be able to have some flexibility to make individualized determinations (within reasonable guidelines). This new legislation in Indiana, sadly, seems to be a step back for harm reduction and making treatment accessible and reasonable..

April 03, 2008
Methadone clinics to get more oversight

Governor signs bill with tighter regulations
By MELISSA MOODY
Melissa.Moody@newsandtribune.com

A new Indiana law further regulating methadone-treatment clinics has appeased a Jeffersonville legislator and the clinic’s operator, but a county commissioner and resident say more needs to be done.

The bill has been championed by State Sen. Steve Stemler, D-Jeffersonville, as a much-needed to measure to help stop the steady flow of out-of-state residents coming into Southern Indiana to seek methadone treatment.

“This has been pretty high profile for (Clark) County, but it’s a state law and will affect the whole state as well,” Stemler said.

Southern Indiana Treatment Center’s Regional Director Tim Bohman — who oversees the local methadone clinic off Charlestown Pike — said the clinic’s operators are pleased with the outcome of the bill, and that it won’t affect the treatment provided to patients at the clinic.

“It basically set up regulations around good, quality treatment, and it didn’t affect access to care,” Bohman said. “We’re happy with the way the bill turned out.”

Indiana Gov. Mitch Daniels last week signed the bill that will increase the requirements regulating methadone clinics throughout the state, which are used to treat opioid addictions, such as from heroin. The measure received overwhelming support in the state House of Representatives and the Senate, “which is something (Daniels) always looks for when he signs a bill,” said Jane Jankowski, communications director for the governor’s office.

Previous laws governing Indiana methadone clinics were significantly less strict than laws in surrounding states, including Kentucky, Ohio and Illinois.

However, some residents and local leaders think the new bill doesn’t go far enough.

“There is more to do as far as protecting the citizens of Clark County rather than patients at the clinic. There was more emphasis on patients’ rights than residents’,” said Clark County Commissioner Mike Moore. “If the hospital won’t let you leave their grounds after receiving medication, then why in the world can the clinic.

“I don’t think kids should be on the grounds of the facility or a day care should be available. You don’t need to be walking kids into that facility or leaving kids in the car while parents are getting their dose.”

Moore and a resident living near the clinic visited the Senate in Indianapolis while the bill was being discussed by the General Assembly to advocate for the residents of Clark County. Of the three issues Moore raised, marijuana testing for patients was the only to make it into the final bill.

Moore said he also wanted to see the take-home dose given to patients decreased from 30 days to three, instead of from the 30 days to 14 which made it into law. He attributed the take-home dose — which is still larger with the more strict regulations than in surrounding states — to the high numbers of patients from out-of-state getting treatment at Indiana methadone clinics.

“Until we’re only dealing with Indiana patients, we’ll have the problems we’ve got,” he said. “I’m not satisfied, but I’m at least happy with they addressed marijuana testing.”

Many area residents pointed to the lack of marijuana-testing requirements as the reason so many people traveled here from out of state to seek treatment; marijuana testing is required in surrounding states.

Senate bill 157 will require methadone clinics to test all patients, both before receiving treatment and periodically throughout treatment, for drugs, including marijuana.

“It appears that legislation is moving in the right direction,” said Derrick Vogt, a county resident who lives near Southern Indiana Treatment Center. “I still would like to see tougher legislation concerning the patients and driving after their dosages.”

Another major component of the legislation is the creation of a central registry of patients receiving treatment at methadone clinics throughout the state. The registry will be established and maintained by the Indiana Family and Social Services Administration’s Division of Mental Health and Addiction.

It will be updated as information regarding patients is received from clinics, which are required to report patient information and progress on an at least monthly basis.

“We will be able to track the results and see how effective these clinics are,” Stemler said. “It is going to require (the state social services administration) to have greater oversight.

“We accomplished what we wanted and hopefully the results will prove successful.”

At a glance
Senate Bill 157, recently signed by Indiana Gov. Mitch Daniels, strengthens requirements for methadone clinics throughout the state. Here’s how:

• All methadone clinics must be approved and certified by the Indiana Family and Social Services Administration’s Division of Mental Health and Addiction, including each location operated by a clinic provider.

• All methadone-treatment programs must periodically and randomly test, including before receiving treatment, for drugs, including methadone, cocaine, opiates, amphetamines, barbiturates, marijuana, benzodiazepines and any other drug that may have been abused by the patient.

• Each methadone clinic operator must submit an annual report outlining the addiction-diversion program used, including the program’s drug testing procedure for testing a patient during treatment.

• The mental health division will conduct on-site visits of all methadone clinics annually.

• The mental health division will establish and maintain a central registry of all patients in the state being served by methadone-treatment programs, and all clinics must provide, at least monthly, information required by the department concerning patients in the addiction-treatment programs.

And the comments that the law "didn't go far enough" ??? Addicts should (obviously) be treated as human beings, and receiving a medication like methadone should be be treated as such- it is a prescription drug. One comment included states that if patients cannot leave the hospital after taking a medication, why should clinics let patients leave? They implied that this was a public health and safety issue. As if the addicts are a threat to society once they have ingested their methadone. And that kids shouldn't be exposed to that. Well, kids see their parents drink alcohol, or ingest food, or take prescription or over the counter meds. They are usually taught themselves to drink their cough syrup or take their antibiotics when ill as a child. Why couldn't they be with their parent when that parent drank a cup of medication? And in fact, if you want to encourage responsible parenting and treating substance abuse and dependence within the context of "protecting the kids," then best to facilitate that logically. If kids are banned in the clinics, do you want parents to leave them home alone? Or do you want this to become a barrier to treatment for individuals with children? As for the limit on take-home doses- every extra day you make that patient come to the clinic is a day they have to wake their kids up early, get them all ready, and haul them off to the clinic ("exposing" them far more often, which is apparently a problem in these folks' eyes. So either way, once a patient is stabilized, treat them like an adult, and minimize the intrusion upon their family and their life.

The new law minimized the take-home dosing period, from the usual 30 days (which takes over a year to attain anyways I believe) to 14 days, or two weeks. In fact, the gent quoted in the article said he thought three (3!) days should be the maximum- meaning patients, no matter how long they'd been sober or how functional they are, should need to come to the methadone clinic every three-four days. And the required testing for THC- if someone is smoking pot and able to stay off heroin, why penalize them? Most clinics test for pot anyways; it's standard in the "NIDA five." And most do penalize you for it to some extent- they won't allow you take-homes if you smoke, but they often won't kick you out completely- but with the feds stepping it up, they may not have any choice at some point. Why take it as far as to specify this requirement?