Methadone caregivers say they focus on treatment, not profits

For Duluth’s Lake Superior Treatment Center — and for more than half the metha­done clinics in the country — methadone isn’t only a treatment. It’s a business.

“I would say it’s lucrative,” Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, said of for-profit methadone clinics. “If not, they wouldn’t be opening (clinics).”

Financial records showing the profitability of the Lake Superior Treatment Center or its parent company, Florida-based Colonial Management Group, aren’t publicly available. Colonial Management, the second-largest group of methadone clinics in the country, keeps that information closely guarded. A corporate medical director for the company, Dr. Tom Payte, said Colonial Management has about 25,000 patients spread throughout its more than 50 clinics in 18 states across the country.

Though some in the drug treatment field question whether a quest for profits might pose a conflict of interest, others dismiss the concerns.

Payte said his focus is not on the money the company makes but on the quality of care the clinics provide. And he said he sees little difference between for-profit and nonprofit providers.

“In reality, for-profit and nonprofit programs are operated under the same guidelines and regulations,” he said. “In some cases, the for-profits may be doing a better job of delivering services.”

The number of for-profit methadone clinics is growing. Nationwide, according to the Substance Abuse and Mental Health Services Administration, the number of for-profit methadone clinics grew 21 percent from 2003 to 2010. During the same time, the number of nonprofit clinics grew 2.3 percent.

“If it is a for-profit agency, doesn’t that imply to some degree a conflict of interest?” asked Don Jarvinen, who trains chemical dependency counselors at the Fond Du Lac Community College.

Some of Jarvinen’s students have gone on to work at the Lake Superior Treatment Center. Jarvinen said those students have shared concerns with him about the clinic, saying counselors have high patient loads and aren’t able to provide the counseling needed to go with the methadone.

The director of the Lake Superior Treatment Center did not return repeated phone calls for comment. A representative for Colonial Management Group, which owns the Lake Superior Treatment Center along with more than 50 other clinics across the country, told the News Tribune from Florida that the company does not speak to the media.

However, Payte, who has oversight of the treatment standards for Colonial Management Group’s Minnesota clinics, did speak with the News Tribune.

Payte, who has worked in methadone treatment for 40 years and before working with Colonial Management operated two clinics in Texas, said he’s careful to make sure that the company’s desire to make money doesn’t interfere with the care provided.

He said nonprofit programs can end up charging more fees, are less concerned with competition, provide less supervision of methadone use and “don’t seem to be as sensitive to the needs of patients.”

“In the for-profit model, there is a greater opportunity to deviate or be a little more creative in providing the services,” he said. “I was a little suspicious in moving to the corporate model. But I was pleasantly surprised. I feel like the treatment can co-exist with the business side of it.”

Reasons to stay on methadone

Other experts say that lengthy time in treatment doesn’t suggest a lust for excess profits.

Dr. Robert Newman of New York, who has worked in addiction treatment in the public sector for 40 years, said methadone shouldn’t be considered a cure but a maintenance drug, much like giving insulin to diabetics or medication to an epileptic.

Once an individual has been addicted to heroin, there’s always a risk of relapse, Newman said. Because of that, if his own son or daughter were using methadone for an addiction and considered getting weaned off, “I would beg them not to,” he said. “The first time you shoot up again or the first time you use some kind of prescription narcotic, you can die of an overdose.”

Patients are taken off methadone, but it’s not a quick fix, said Nick Reuter, public health analyst for the Substance Abuse and Mental Health Services Administration. The average length of treatment is 6.8 years, he said.

“There are patients who are now in their 80s who have been continuing treatment for 30 or 40 years,” Reuter said. “What we put in our guidelines is that as long as somebody is in recovery, the decision to wean them off the methadone should be very carefully considered.”

No public-sector alternative

Of the 1,137 clinics in the U.S., 54 percent are for-profit like the Duluth clinic. Parrino said that percentage is growing because the public sector isn’t doing its share.

He said he has heard from state legislators complaining that methadone treatment centers are making profit the central motive and keeping people in treatment longer than they need to.

“I said, ‘That’s possible,’” Parrino recounted. “Some private programs will focus more on how do they increase their margin of profit rather than do they offer additional services to patients.

“I said, ‘But tell me, if you’re so concerned about the growth of the private sector in methadone treatment, what are you doing to counter that? What are you advocating?’”

Newman, who directs the biggest methadone treatment program in the country at New York’s Beth Israel Medical Center, put it more bluntly in defending his for-profit colleagues.

“I don’t understand why, of all services, this one is singled out to be damned for the profit motive,” he said.

Newman, like Parrino, said the public sector should step up to the plate, and he applied his argument to Duluth.

“The fact that people say: ‘Well, we’ve only got one clinic and it’s a profit-making clinic and we’re concerned about it,’” Newman said, “Hey, OK, I’ll accept all your reservations. What are you doing about it? There’s no reason why Duluth could not develop a methadone treatment alternative for everybody who wants it.”

Even if there is a monopoly, it doesn’t mean clients are paying too much, Parrino said.

“If you figure the average charge for a private patient in a private clinic per week is anywhere between $70 to $90 per week — while that’s not a national standard, it’s a sort of ballpark figure,” Parrino said. “Are you seeing programs charging much greater than that? Like $150 or $200 per week? Not to my knowledge.”

Clients at the Lake Superior Treatment Center are charged about $17 to $22 a day, or $119 to $154 a week, according to patient records examined by the News Tribune and data provided to the newspaper by Medica and the Minnesota Department of Human Services. State data suggests that the average cost to treat a patient on methadone is about $3,000 a year.

Successor to methadone?

Whatever success Colonial Management Group and other methadone providers experience will be short-lived, predicts Ted Jackson, a financial journalist who has looked at the economics of methadone for the publication he founded, Treatment Magazine. An alternative opiate treatment called Suboxone works better, he said, and can be prescribed by certified doctors, meaning a visit to an addiction clinic isn’t required.

The problem with Suboxone is that it’s a brand-name drug and much more expensive than methadone, Jackson said. But when a generic version becomes available, cost will be less of a factor.

It’s not clear when that will happen. U.S. patent protection for the Suboxone tablet ran out in 2009, according to an October 2011 article in Bloomberg news. But the manufacturer, Reckitt Benckiser of Great Britain, introduced a Suboxone film strip that dissolves on the tongue, which has patent protection until 2025. Reckitt marketed the film version by offering U.S. consumers $45 per month toward their co-payments, Bloomberg reported. The company introduced the Suboxone film in September 2010, and within the first half-year, it accounted for 41 percent of the drug’s sales.

In the face of that success, so far no manufacturer has offered a generic version of the Suboxone tablet. But there’s nothing to prevent them from doing so. If the generic does become available, methadone treatment centers likely would face a loss of business.

As for the future, Jackson said: “I consider the methadone clinic business to be an extremely risky business.”

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