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Boston’s only public methadone clinic may shut

City would shift care from its methadone unit

Boston health officials are poised to close the city’s only public methadone clinic at a time when heroin overdoses, which methadone is used to combat, are rising dramatically across the state.

Shutting the clinic, which has offered methadone to opiate addicts for 40 years, would mean that hundreds of clients served every day at the Frontage Road site and at a separate counseling center in the South End would be treated by private providers, possibly as soon as July 1.

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Barbara Ferrer, executive director of the city’s Public Health Commission, said that operating the clinic, which costs $2.4 million a year, “is not necessarily what the health department should be doing with scarce resources.”

Ferrer cautioned, however, that the city would not end the service if officials are unable to reach agreement with a high-quality provider. “We have no intention of ever signing off on anything that would compromise our ability to offer a great service,” she said.

The city wants to redirect the clinic’s budget to Mayor Martin J. Walsh’s proposed Office of Recovery Services, health officials said. The mayor, a recovering alcoholic, made strengthening the city’s support network for substance abusers a cornerstone of his campaign.

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In a statement, Walsh said that advances in addiction treatment, as well as the emergence of more providers, have given city officials a chance to reconsider funding priorities and strengthen services that no other provider can offer.

“By opening an Office of Recovery Services,” Walsh said, “we’ll be able to strengthen coordination and collaboration among our partners to improve access to care, identify barriers to treatment, and increase outreach efforts to the people that need it most.”

‘Most patients . . . have been to detox probably 50 to 100 times, they always relapse, and they have to find something.’

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Last month, Governor Deval Patrick declared a state of emergency to combat the escalation of opiate abuse in Massachusetts.

The proposal to shut the clinic was approved in March as part of the health department’s preliminary budget for the next fiscal year. A final vote is scheduled April 17. Talks are continuing with private providers to explore whether the city’s clients can be absorbed elsewhere. One of those providers is Bay Cove Human Services , a large nonprofit that serves a wide array of needs at more than 160 locations in Boston and southeastern Massachusetts.

Despite assurances that methadone treatment will be uninterrupted if the city clinic closes, the possibility of a shutdown has raised fears among current and former staff that uninsured and indigent clients will be set adrift.

Mimi Vitale, a nurse who retired in 2011 after 22 years at the clinic, called the proposal “a bad decision.”

“It just makes me really sad because a lot of these people are homeless, and the only person they see is the nurse that day,” Vitale said. “Most patients go every day. They have been to detox probably 50 to 100 times, they always relapse, and they have to find something.”

Methadone is a synthetic narcotic that has been used for decades to reduce the craving for opiates, such as heroin, and their withdrawal symptoms. Treatment is sometimes needed for years to help prevent a relapse. The cost of treatment varies, because different patients can require different doses of the medication.

One current clinician, who asked not to be named for fear of retribution, said he is concerned by the timing of the proposal and its potential consequences.

“We’re in the middle of a heroin epidemic,” the employee said. “The clients are unraveling because they’re not sure if their insurance will cover the treatment.”

The city’s methadone clinic on Frontage Road serves more than 400 clients every day of the year. The program also offers individual and group counseling on nearby Albany Street.

Four private methadone clinics, plus one run by the Department of Veterans Affairs, exist in Boston.

Bill Sprague, president of Bay Cove Human Services, said that discussions about absorbing some of the city’s methadone clients have begun between staff at the Bay Cove clinic and the city facility. “We have some capacity to expand,” Sprague said.

Ferrer said the city wants to make sure that uninsured patients are protected, and she said a private clinic would have to accept state funding that the city now receives for its uninsured clients.

The state Department of Public Health channeled $291,000 to the city’s clinic in fiscal 2013, but those funds did not cover all costs associated with the uninsured, said Nick Martin, spokesman for the Boston Public Health Commission.

Other unreimbursed expenses at the clinic and counseling center include overhead and salaries for 23 full-time employees, health officials said.

News of the planned closing was delivered to staff members March 21 by a Public Health Commission supervisor, the longtime clinician said.

“For 10 to 15 minutes, she hemmed and hawed and finally pronounced that the clinical counseling and also the medical end — the methadone component — are being privatized at the turn of the fiscal year,” the staff member said. The new fiscal year starts July 1.

“What’s most mystifying is the silence that’s surrounding this,” the employee added.

The clinician said that clients have been given a one-paragraph printed statement informing them that the program is being privatized and that methadone treatment will continue uninterrupted.

Low-income residents with insurance through MassHealth are covered for methadone treatment, said Julie Kaviar, spokeswoman for the state Executive Office of Health and Human Services.

The city’s health department is scheduled to present the results of its discussions with private providers at the April 17 meeting of the Board of Health. At that time, the mayorally appointed board will vote on the budget and the proposal to close the methadone clinic, Martin said.

Maryanne Frangules, executive director of the Massachusetts Organization for Addiction Recovery, an advocacy group, said she is withholding judgment on the possible closing until more details emerge.

Methadone, she said, “is one of many effective options. We need to keep as many options out there as possible.”

Brian MacQuarrie can be reached at macquarrie@globe.com.
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