This is an archived article that was published on sltrib.com in 2006, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
A rising tide of prescription drug deaths has Utah looking to tighten regulation of its nine methadone clinics.
Any changes are probably a year off and likely to face resistance from clinic owners who fear being driven out of business. Existing oversight by the federal government and national accrediting bodies is burdensome enough, they argue.
But Victoria Delheimer, of the state Methadone Authority, says Utah's regulatory environment is lax compared with other states. She is seeking input from clinics on what's reasonable and what's not, but says patient safety must come first.
"Most of the clinics are doing a good job, but I think we can be tighter, cleaner and safer," said Delheimer.
Prescription narcotics, or painkillers, are the leading contributor to fatal drug overdoses in Utah. The single most lethal is methadone, which caused no deaths in 1995, but was tied to 113 in 2005.
There's no proof that methadone clinics are to blame for the growing death toll, says Delheimer. For decades, methadone has been safely and successfully prescribed to battle opiate addictions. Nationally, studies have linked the overdose problem to methadone prescribed by physicians for pain management or acquired illegally through doctor shopping, theft and the Internet.
But tracking the origin of fatal doses in Utah is complicated.
The state doesn't require methadone clinics to report patient fatalities unless the patient dies at the facility, says Ken Stettler, Utah Human Services Licensing director. "You could have clients who succumb at home and we wouldn't hear about it. Frankly, that's the more likely scenario,"
In addition to strengthening her own supervisory powers, Delheimer wants to mandate more frequent urinary analyses of clients and face-to-face visits with doctors and counselors.
"Accrediting bodies call for eight urine tests a year. Some clinics do more and others do less, but that's worthless," says Delheimer, who is proposing that random, observed urine tests be done every week for the first three months of treatment, bimonthly the next three months and monthly thereafter.
Delheimer says there are one or two "problem" clinics that, in her view, should lose their accreditation. But she declined to name them and stressed that all Utah clinics are fully accredited and in compliance with federal law.
Her fix-it plan gets mixed reviews from the industry.
Joel Millard, director of Project Reality, the state's only publicly funded methadone maintenance clinic, says "her heart's in the right place, but the devil's in the details."
But Jerry Costley, director of Metamorphosis with sites in Salt Lake and Ogden, says, "I'm worried about increasing the cost of treatment. Most of our clients are private-pay. We have no contract with the state, and yet the state wants to come in and impose mandates."
Existing rules are designed to be flexible, Costley contends. "We have to make judgment calls weighing a patient's safety against his or her desire to live a reasonably normal life that includes working and traveling."
Methadone is commonly used to wean addicts off heroin, but some never achieve total abstinence and stay on methadone for years, or life. Such patients can earn "take-home" privileges, meaning they can pick up two weeks to one month's worth of methadone at a time.
"We believe in personalizing and individualizing counseling and drug tests. Some patients require this more than once a week, and some less," says Costley. "If we can reasonably demonstrate we're meeting patients' needs. I really don't think we need more regulation."