NIMBY Town Gets Sued

 

An Angry NIMBY Mob

 

 

The town of Warren, Maine is being sued by CRC Health Corporation for violating the Americans with Disabilities Act.

The whole ordeal started when a businessman of Warren, seeing the need for a drug addiction treatment center after a nearby methadone clinic was shut down, asked state officials about locating a methadone clinic in Warren. They referred him to CRC Health, the nation’s largest mental healthcare corporation, and the owner of one of the clinics where I work as medical director, Mountain Health Solutions in North Wilkesboro, NC. CRC representatives came to talk to the businessman. They listened to his concerns, assessed the need for a treatment center, and looked at possible sites. After finding what appeared to be an ideal location for the new clinic, the idea was taken to Warren’s planning board, which approved the plans.

Then the townspeople of Warren got involved.  Many were outraged. They didn’t want an addiction treatment center in their town. They started petitions to rid their town of any potential methadone clinics, and spoke out against it at town meetings. This is the modern-day equivalent of a mob of villagers taking up pitchforks and other farm implements to push the undesirables out of town, except that the “undesirables” are really friends and family members who suffer in silence with the disease of addiction.

First, a 180-day moratorium on the approval of any methadone clinic was put into place by the town’s governing bodies. Then the town passed ordinances that severely limited where such a clinic could be located. Clearly, the town’s intent wasn’t appropriate zoning, but rather preventing an addiction treatment center that used methadone as a means of treatment.

This NIMBY-ism is, of course, not only discriminatory but illegal under with American with Disabilities Act. The ADA guarantees citizens with addiction have as much right to get treatment as citizens with other diseases. It’s illegal for a town to pass laws that prohibit addiction treatment facilities from operating in that town.

So CRC Health sued the town of Warren in federal court for violating the American with Disabilities Act – and won $320,000. Though the town’s insurance company ended up paying, this sent a clear message that violations of the ADA won’t be tolerated.

I love that CRC sued this town!

Too often, companies that own methadone clinics just want to stay out of the public eye, for fear of negative community reaction. It doesn’t matter if they’re for-profit or non-profit.

I don’t agree with that. We who work in medication-assisted treatment are providing one of the most evidence-based treatments in all of medicine. We don’t have to be ashamed or embarrassed about what we are doing, so let’s have a public hearing on the matter. I can defend what I do for a living much better now than when I worked in primary care, seeing mostly the worried well.

But wait! The plot thickens…now it appears that the town of Warren again delayed approval for the methadone clinic, due to actions of town leaders and citizens. Despite the order of the federal court, the town of Warren had enacted so many zoning laws that CRC Health wasn’t able to find a viable location for their clinic. By this time, CRC Health had been working on their project for nearly two years. Due to the repeated delays, CRC Health is proceeding with its original federal lawsuit against the town.

I hope they win millions. That would send a clear message to town leaders that discrimination against people with addiction won’t be tolerated.

In a remarkably similar case, owners of an opioid treatment program just won $650,000 from the town of Berwyn, Illinois. Just like in Warren, Maine, the clinic was originally approved – in 2008 – but the NIMBY townspeople got involved, and the town officials stupidly refused to allow the treatment program to open. A federal court judge said the zoning laws of Berwyn were motivated by intent to treat its clients differently from other medical patients.

The city of Berwyn was also ordered to pay the treatment program’s legal fees.

Sweet. I am delighted by this action.

In the past, I assumed methadone clinics were big money-making endeavors, but that’s not the case. I’ve learned this the hard way. It turns out that under the best circumstances, meaning the licensure and approvals from all the necessary organizations (DEA, CSAT, state methadone authority, and state’s department of health and human services, to name but a few) go as smoothly as possible, at least a quarter of a million dollars are needed to cover start-up costs. If there are any delays, costs quickly rise. Now that Suboxone is an option, methadone-only programs are seeing a drop in treatment demand. In other words, starting a new opioid treatment program is now a significant financial risk.  Many non-profit organizations don’t have the capital to take that risk, even though medication-assisted treatment with methadone is proven to save more lives than perhaps any other medical intervention.

A few years back, I agreed to be the medical director at one brand-new program that was very close to my home. I liked the owner, and believed she would be dedicated to quality care. But that clinic didn’t have the financial backing I was lead to believe they had. At the fourth month of operation, suddenly the staff learned the landlord was evicting the clinic for non-payment of rent. The staff had to hustle to get patients all transferred to other clinics, in some cases back to the same clinics they’d transferred from in the first place. It was a disaster, and the clinic closed owing me thousands of dollars. It was an expensive lesson.

So yes, companies that accept financial risk to open a methadone clinic, for-profit or non-profit, should be able to recoup losses incurred by the actions of towns that violate Americans with Disabilities Act. But the awards aren’t only about actual costs; towns that unethically resort to NIMBYism should pay when they deny treatment to sick people, as a means of discouraging other towns from violating the ADA.

In fact, I know of a few towns in Eastern Tennessee that could use a dose of that medicine.

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12 responses to this post.

  1. Posted by Jaime on November 14, 2012 at 2:41 pm

    So could this potentially be done in Eastern TN as well?

    Reply

    • If a town has rejected a proposed methadone clinic because they don’t want a methadone clinic anywhere in their town, that’s illegal. They can have reasonable zoning requests, but if it’s obvious the zoning is designed only to keep out a clinic, the party looking to locate a clinic can sue, as I understand it. The party may decide they don’t want to bother with a lawsuitm though, for fear of bad press.

      Reply

  2. Posted by CateS. on November 14, 2012 at 2:08 pm

    Hey Dr. Burson,
    I’m sure, with this blog, you will be hearing a lot from us East Tennesseans. In the beginning of this year there was a clinic set to be opened in Piney Flats, Tennessee which is 10 minutes away from us. All they needed was for their parcel to be rezoned. The location was in an industrial park that houses big plants mostly. They were concerned about their workers and their property. Then the citizens got involved. In an article talking about this subject it said, citizens have fought back at the prospect of having drug abusers flocking to their neighborhoods to partake of yet more drugs. There was outrage and they circulated petitions. This needs to end. The naivety of anyone opposing this life saving medical treatment is just baffling. This same scenario has played out all over our region. I really become so disheartened by this every time it happens. Are there any advocacy groups anywhere near this region? And if so, how would l contact them. Thank you!

    Reply

    • Thank you so much for writing. Yes, there are advocacy groups, and the main one is th National Alliance for Medication-Assisted Recovery, or NAMA for short. their home page is: http://www.methadone.org and they support both methadone and buprenorphine as treatment options. Their website has tons of good stuff, and contact information. There doesn’t seem to be a Tennessee chapter…so maybe you’ll want to start one!

      also, AATOD, the American Association of Treatment of Opioid Dependence, website is http://www.aatod.org has some advocacy action. I know they spoke out against the new regulations on methadone clinics that were passed in Tennessee.
      I think it always helps to write elected officials and tell them what you think.

      I don’t know who was trying to open a clinic in Piney Flats. It sounds like they didn’t file a case with the federal court. Not knowing the details, I don’t know why not. It may not have been a clear-cut case. It’s a shame, because it means more people in Tennessee will die, lacking access to medication-assisted treatment.

      Reply

  3. Posted by Benjamin K. Phelps on November 18, 2012 at 4:14 pm

    I, too am disheartened, let down, & scared at times when I keep seeing this happen all over the place. Maine itself went through this already back in about 2004 when a methadone patient wanted to open a clinic herself (I think it was in Portland or near there) & they put a moratorium on it, held a town council meeting to clearly label MMT clinics as “sole-source pharmacies”, & finally rezoned the whole dang town to zone out the so-called “sole-source pharmacies” – well, not all the way – they left 1 single street in town where 1 could be located, but there was no property/building available there on that street. So guess what the final result of that rezoning was? You got it – no clinic could open in that entire city/town. She fought back, thankfully, & eventually won, but it took her a L-O-N-G time to do so. I think she named it Turning Tides or Turning Tide. Anyway, I applauded her, & followed the case until she won, commenting frequently on the blogs where the opposers would comment negatively on it everyday. One in particular was a mother who’d lost a daughter to an OD of methadone. So now the countless hundreds of thousands of people saved everyday by MMT from legal charges, death, OD’s, HIV/AIDS, needles, etc, etc were supposed to all just suffer without any treatment at all (at least if it involved medicine) b/c of her daughter’s bad choice to play with a drug she didn’t know much about. Heck, she could have potentially OD’d on purpose for all anyone knows. Anyway, she got on there & preached the gospel of “One Pill Can Kill” everyday to anyone who’d listen; & that’s her prerogative & it’s fine to warn of the dangers of abusing methadone. However, she did it VERY clearly to instill fear into everyone in Maine b/c she kept saying her daughter was the victim of a drug addict selling her methadone; her daughter was simply a poor victim in this thing, not an addict, or drug-seeker, etc. And as much as I really & truly HATED to do it, I finally went on there & told her that while I mourned her loss along with her, she needed to recognize that her daughter was one of the despicable addicts that she was calling all of us everyday, as well! She wasn’t an innocent victim in her own death unless she had her mouth pried open while someone poured methadone in & she then had no time or way to get to a hospital before it killed her. I told her that this is not uncommon for people that know nothing about methadone to get hold of a 40mg tablet or even liquid, not believe it’s that strong, take a single 40mg pill & wait half an hour before deciding it’s not working & taking another. Now you have an OD on your hands. They start feeling it another 15-30 minutes later & are happy, they lie down to enjoy it, pass out, & vomit, then choke on it OR just die from respiratory depression. And then there’s the liquid, which every bureaucrat seems to believe is safer to give to addicts, yet that’s the stuff kids see in peoples’ homes that are idiots & don’t keep it locked up/store it in the fridge, & they drink it, thinking it’s Kool-Aid! Or, another addict gets hold of it & thinks “well, there’s not much liquid in here – it CAN’T be dangerous to take such a small amount…” And they swallow 100 or 120mgs & “wake up dead”. I am aware that some people are detestable & will put methadone out on the street when they get takehomes. It’s a shame – truly. But this lady wanted to suggest that IF MMT was going to be allowed to continue, they should NEVER give a single takehome out ever again – not even if we’ve been there 30 years with full compliance. And she didn’t mind making it crystal clear that she didn’t mind at all if these people that were having to drive hundreds of miles to the nearest clinic that would be helped by this new clinic KEPT ON having to drive hundreds of miles each & every day of their lives. Never mind the expense on these poor people, the inconvenience, the toll on their bodies to have to drive that far & get up that much earlier every morning, 7 days a week until they have a takehome or 2 (& remember – she wants to do away with ALL takehomes…) That’s ridiculous to suggest, it’s unfair – no other treatment in the country or world is restricted like ours is, it doesn’t make the streets safer for addicts like her daughter – she’d have merely gotten a different opioid to OD on, or bought methadone off a pain patient. And we all know how many of them are selling their meds, don’t we? I truthfully believe (REALLY!!) that more pain patients sell meds than clinic patients do by a long shot… even with monthly takehomes. B/c we take our medicine daily at a given dose, whereas those patients never had to titrate at a dosing window, being forced to take the amount in the cup each & every day until they needed that amount to keep from withdrawing. So they might’ve been given 100mg/day, but stopped titrating @ 80mg, leaving the rest to sell for bill money each month, which won’t make them sick. And yes, I do understand monthly THs allow the person to taper some & potentially sell their meds, but having to dose that one day @ the clinic each month in person sort of negates that a bit b/c it would knock them for a loop somewhat to suddenly take a really high dose that they’re not used to once they’ve tapered down a good ways, & the clinic personnel could see this if they’re in the clinic for long.
    As usual, I’ve typed WAY too much. But this topic is SO important to all of us – patients & clinic staff as well – & it needs to be addressed in some form or fashion to an extent where it’s made crystal clear that discrimination against opioid treatment centers WILL ABSOLUTELY NOT be tolerated in ANY city or state. I mean they need to award such an exorbitant amount a few times that will no doubt be reduced on appeal, but will cause so much hassle that people don’t dare go down that road in the future. Set an example, in other words. I wish all my MMT fellow patients the best, & don’t let this stuff kill your spirit – if all of us stand up to this type of thing, they won’t get by with doing it in ANY case where the would-be owners are willing to fight it. And I, for 1, will put my $ where my mouth is – trust me! I’ll go to a picket or a meeting in the town hall if it’s where I can possibly get to it in order to stand behind anyone trying to help people like me. And I commend you again, Dr Burson, for the work you do, this blog, & your attitude/outlook on our treatment in general. I think I speak for us all when I say “we appreciate it very much”!!

    Reply

    • The Turning Tide facility was closed by federal drug agents in 2010 after citing threats to public health and safety. The owner director was later arrest for possession of cocaine. This did not further the cause or set resident minds at ease.

      And CRC is very much a for-profit corporation. It has investors. Why, I ask, plead the teddy bear approach to treatment when there is significant financial gain? What assurance do even clients have that it is their best interests that are at stake. Similarly, with other diseases, breast cancers, for example, there remains tremendous financial gain to not finding better treatment nor even, a cure.

      And, regarding the Warren situation, the landowner is portrayed as a guy with a heart – rather than a guy with his hand out. (Is he, in fact, an investor?) And, why would CRC fight to place a clinic in an area that is hostile to it, rather than locating it where there would be less stigmatization for clients – for example – within area hospital grounds, (clients could be on hospital grounds for many reasons).

      The business side of CRC, and the landowner, seems to be the only true concern here.

      Reply

      • I’ve read this comment a few times and still don’t understand it. Are you implying because one OTP owner was a criminal and probably an addict, that means all OTPs are owned by criminals/addicts?? Because that’s nutty.
        I suspect CRC wanted to put a clinic in Warren because that’s where the need was. And please tell me what (for profit) hosptial wants an OTP on their site.
        Healthcare is a business in this country. You may not like that – but it is what it is. If you want more socialized medicine like is found in Great Britain or Canada…vote for candidates that will bring that about. But so far, the majority of people in this country appear to be content with for-profit medical care.

  4. Posted by Benjamin K. Phelps on November 18, 2012 at 4:15 pm

    Sorry, didn’t check the follow-up comments subscribe box & I want it to notify me….

    Reply

  5. Posted by Paul Severe on November 20, 2012 at 7:22 am

    Very interesting post/overall blog. I am a law student currently working on a research paper about the legal pathways for treatment providers facing discriminatory zoning regulations. Its encouraging that municipalities are beginning to simply settle these cases. Prior to a 2nd Circuit Case (Helping Hands LLC v. Baltimore County), it appeared that the underlying legal issues were fairly settled. I was wondering if you had any thoughts on that case?

    Reply

  6. Posted by tramadolyous on December 7, 2012 at 6:37 am

    Tramadol is one of the most widespread, addictive and readily available drugs today. Regular use results in physical and psychological damage and dependence.
    There are thousands of people that have used, gone through treatment and now live normal, healthy lives.

    Reply

    • Posted by Benjamin K. Phelps on December 9, 2012 at 12:30 am

      Uhhhh, thanks, I guess??? But sorry, no cigar. Tramadol is basically THE weakest opioid available. It’s not even a controlled substance, even though it does have some abuse potential. It’s FAR from one of the most addictive drugs available. Not even close. That label gets attached to so many drugs that it’s become a term that nobody takes seriously – least of all kids, whom we need to hear the message (the truth about the dangers of drugs.) Yes, it’s dangerous; yes, it’s addictive. But it’s not gonna be in that fantasy category of “hooking you with one try,” & it’s certainly not going to cause dependency in any quick period of time. However, it can easily cause nasty side effects from high doses, dependency with daily use, & an opioid addiction that leads to the abuse/use of heavier opioids to cope with the withdrawal and/or intolerable side effects of the tramadol itself. But as a society, we need to stop telling kids & everyone who’ll listen that EVERY drug is one of the most addictive drugs known to mankind. It’s silly & only causes the opposite of what you’re trying to do to end up happening. Once a kid thinks s/he’s been lied to about drugs, that healthy fear of them disappears & they jump from drug to drug, trying them all & often times, one of those drugs in the chain eventually does grab them. That’s what happened to me. I don’t pass the blame, but I do wish people had been a bit more “real” with me about what was likely to happen with various drugs, rather than just telling me that they make you crazy, don’t even feel good, that they physically hook you with one single try (no drug does that, even though you may like a drug enough that you want to use it again right away.) And what gives with movies that show a crack addict shivering, vomiting, & nearly pulling his hair out in withdrawal from crack?? That’s the silliest thing I’ve ever seen. There IS NO withdrawal of that sort with crack. Only depression, & a SERIOUS crash & burn that causes the deepest compulsion you’ll ever know to go & get more, even if it means spending every cent you have & using your savings & checking money, kids’ college money, parent’s retirement money, & stealing from the local church collection plate. But physical dependency on crack of the painful withdrawal type? Nope. Doesn’t happen, sorry. Been there, done that. Pretty much only opioids, benzos, barbiturates, & alcohol are the culprits behind those types of withdrawals. I’m NOT saying there aren’t ANY withdrawals at all – to be sure, the body does have to have time to adjust when any drug is yanked away. But often times, some of those things that have to readjust are not the types of things that cause physical pain, insomnia, vomiting, diarrhea, violent fits of akathesia/RLS-like symptoms. Can we just tell people the truth about drugs?? It’s really past time that we did.

      Reply

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