As the Lake Superior Treatment Center faces the revocation of its state license, St. Louis County wants to see if anyone else is interested in running a methadone clinic for drug addicts in the Duluth area.
The county expects to send out a request for proposals next week for another business or nonprofit to own and manage a clinic, said Ann Busche, the county's public health and human services director.
A consortium of representatives from St. Louis and Carlton counties, the Duluth Police Department and the Fond du Lac Band of Lake Superior Chippewa met last month to discuss the idea, and the same consortium will choose a provider from those who reply to the request for proposals.
Proposals will be due about 30 days from when they are sent out.
The consortium's selection, however, will only be a suggestion to the state Department of Human Services, which licenses methadone providers.
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Busche said she doesn't know when another clinic might open.
"Our next step would be to have a conversation with the state to say, 'Here's a provider the community can support,' " Busche said.
The DHS on Monday sent a letter to the owner of the Lake Superior Treatment Center, Florida-based Colonial Management, saying it will revoke the treatment center's license after finding myriad chronic and serious violations at the clinic during inspections in August. The revocation is effective Oct. 8; the clinic can appeal it before then. If it does appeal, the clinic can stay open until a final decision is made on the revocation.
If the clinic closes, its 419 patients will face difficult choices. They could find a way to travel to methadone clinics in other parts of the state -- there are clinics in Brainerd, St. Cloud and the Twin Cities area; face a grueling withdrawal from methadone; apply for another form of treatment; or find alternative, possibly illegal, drugs.
The local government attempt to find a provider for a second methadone clinic grew from a failed attempt earlier this year by the Superior Treatment Center -- a separate business from the Lake Superior Treatment Center -- to open a methadone clinic in Duluth. The DHS initially granted that approval but then rescinded it in April after the St. Louis County administration and board fought the state.
"The commissioner did say that a clinic operator should be a local determination," Busche said.
Now, with the Lake Superior Treatment Center facing closure, Busche said the consortium has sped up the process to find another methadone provider.
"If their license is revoked, it's likely the state will say there is a need," Busche said.
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The operator the consortium picks will have to run the clinic differently than the Lake Superior Treatment Center, said St. Louis County Commissioner Frank Jewell.
"Clearly, we don't want the problems we presently have," Jewell said. "I want to see successful treatment."
A News Tribune investigation found that, statewide, nearly 400 people have died from methadone since 2000; about 5 percent of methadone treatment patients complete treatment; the drug has been diverted from clinics and sold on the streets; and the cost to taxpayers for treatment has been about $43 million from 2005 to 2011.
Busche said the local consortium will seek health-care providers who will try to wean patients off methadone unless otherwise indicated.
That could be controversial among some methadone proponents, who say the goal of methadone shouldn't be to wean patients off, but to provide them stable lives no matter how long they're on the drug. Proponents compare opiate drug addiction to a disease and methadone as the medication to treat that disease.
"The successes of methadone are those who stay on it," Dr. Gavin Bart, the director of the division of addiction medicine at Hennepin County Medical Center, has told the News Tribune. "It's not controversial in the world of addiction treatment. There are societal controversies, and it's related to stigma. But no one says, 'My God, you've been on high blood-pressure medicine for this many years? You need to stop.' "
When asked about the potential controversy of tapering patients off methadone, Busche responded: "I'm not an expert in this field. ... I just know that we do have concerns about the things (the News Tribune) has found, and the things found in its license (of the Lake Superior Treatment Center): individuals kept on a certain dose; individuals given an increase in dose without what appears to be stringent ... medical approval.
"We want to ensure that individuals who are able to be tapered can be tapered, and that (in cases of) individuals who need to be on some type of maintenance dose, it is the lowest level of dose that is medically acceptable."
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Busche also said she wanted to prevent patients from selling their methadone.
"We don't want them to have the opportunity to sustain themselves on a half-dose and then they're selling the other half of the dose."
Other than the Superior Treatment Center, owned by Chad Braafladt, no other entity has applied for a license to open a methadone clinic in Duluth in the past year, according to the DHS.
DHS Deputy Commissioner Anne Barry said in a statement that the agency supports the county's efforts to find a preferred provider.
