A California-based company that runs a chain of addiction treatment centers nationwide recently swooped into Anchorage to capture what it called an "underserved population."
Anchorage Treatment Solutions, part of CRC Health Group, operates out of a multistory building on West Fireweed Lane with a license to dispense methadone to patients addicted to opiates like heroin and prescription pain pills. Since it opened in June, the for-profit clinic quickly amassed a client base of about 26 patients, underscoring the city's need, said Kimberley Fischer, the clinic's director.
Tony Ruscella, CRC Health's director of business development, said he first identified that need when looking at the number of opioid treatment programs in the state compared to the population.
According to the national average, there should be at least one opioid treatment program per 256,000 people, he said. Ruscella calculated that about 445,000 people live in a 50-mile radius surrounding Anchorage with one nonprofit methadone clinic.
"This information helped us determine, 'Wow, Alaska is really in need of treatment,'" Ruscella said. "They have one clinic in Anchorage, one clinic in Fairbanks, both are nonprofit and both are capped. It would appear from the data that the state is severely underserved."
In June, the state gave provisional approval to CRC Health in Anchorage as well as ZMG-OTP, an established Wasilla clinic that has expanded its services to include methadone treatment.
The state will complete a site review in 60 days, said Randall Burns, Alaska's opioid treatment authority.
"I think the reason we were most willing to have them enter the market is we believe that there is an unmet need," Burns said. "The waiting lists have been a problem, and we're glad to see a program both in Mat-Su as well as in Anchorage."
Now, for the first time in decades, two for-profit clinics will offer methadone treatment in Alaska, Burns said.
Anna Nelson, the executive director of the state-funded Fairbanks clinic, said there used to be more private methadone clinics in Alaska in the 1970s and 1990s.
"But none of those lasted," she said. "I think partly it's because it's hard to gauge the demand. Heroin and opiate demand has been increasing, and we see that. In private clinics, they have to make a profit. They have to be able to break even, while the nonprofit programs have subsidies."
Before CRC Health moved in, addicts in the city had one option for methadone treatment -- an inundated state-funded facility downtown called Narcotic Drug Treatment Center, Inc. About 20 names currently sit on the nonprofit's wait list, all looking to drop dangerous dependencies on heroin and pain medication, said Ron Greene, the center's clinical director.
"It's only getting worse now," Greene said. "We're seeing so much heroin. It's out of control."
The amount of heroin seized by law enforcement in Alaska skyrocketed from 6.41 pounds in 2011 to 55.12 pounds by 2013, according to the Alaska State Troopers' 2013 drug report.
Greene said he has had to cross names off the waitlist -- hopeful patients who died from an overdose. He has answered phone calls from people seeking methadone treatment who pawned their children's toys to cover their drug habits. Others said they turned to prostitution. All Greene could give them was a spot in line. Now, he said, he refers callers to CRC Health.
"These are people who are asking for help," he said. For them, "the waitlist means despair."
The Alaska Legislature allocates money annually to the nonprofit clinics in Anchorage and Fairbanks. The Anchorage clinic can dispense methadone to about 100 patients, and Fairbanks can treat about 40. They prioritize pregnant women, and patients pay based on their ability. The minimum monthly price for methadone treatment is $275, Greene said.
At CRC Health, a cap on patient intake does not exist. It does not take Medicaid like the state-funded clinics, though it does bill third-party health insurance. Here, methadone treatment costs $480 each month, said Deb Cummins, CRC Health regional director.
'Replacing one drug with another'
Methadone is not the only way to treat an opiate addiction, though it may be one of the more controversial. The federal government classifies methadone as a Schedule II narcotic, meaning it has a high potential for abuse. It works on opioid receptors, much like heroin or morphine.
"It's seen as the traditional addiction treatment, as replacing one drug with another," Nelson said. "We wish that there were other ways to do it other than giving methadone, but it gives people their lives back. They're not high."
At the clinics, nurses or pharmacists dispense daily doses of methadone -- a red, cherry-flavored liquid -- for patients to drink. It's long-term treatment that aims to reduce the withdrawal symptoms felt by addicts when they stop taking heroin or pain pills.
Patients must come in every single day for their does for about six months. Then they can begin bringing a month's worth home, though they are often subject to random drug tests and calls in to the clinics to show they have not taken more or less of their dosage than scheduled, Greene said.
The key, Greene said, is reaching the therapeutic dose of methadone so the patients are not experiencing withdrawal symptoms like muscle aches, insomnia and anxiety, but also not getting high.
Fischer said she has opened other CRC Health clinics in the country and has watched patients leave if they don't receive their methadone dose on time.
In the new linoleum-floored Anchorage facility, people began walking in and calling for treatment before doors opened, she said.
Unlike the seven-day-a-week nonprofit clinics, CRC Health dispenses methadone six days a week. On Sundays, patients take home their dose of methadone in a bottle that they must keep in a lockbox and return on Monday, Cummins said.
Greene said he fears patients just starting out on the methadone treatment program will sell the drug on the streets, but Cummins said it shouldn't be an issue. She said a physician will determine if a patient is stable enough to take home the dose. If not, he or she will have to wait until Monday.
"We're not just handing out medication to people who don't need it," Cummins said. "These are people who have a disease that requires medication for them to be able to function."
CRC Health also plans to open clinics this year in Cedar Rapids, Iowa; Ann Arbor, Mich.; and Lynchburg, Va.
Contact Tegan Hanlon at email@example.com.
Alaska Dispatch Publishing